Estrogen-Only HRT Not So Risky in 50s
Lower Estrogen Risk Seen for 50-ish Women With Hysterectomy
In an editorial accompanying the LaCroix report in the April 6 issue of the Journal of the American Medical Association, Washington University researchers Emily S. Jungheim, MD, and Graham A. Colditz, MD, DrPH, have a far different opinion of the new WHI results.
They note that the WHI was designed to see whether HRT protected against heart disease. Today, HRT is used to treat symptoms of menopause -- but the women in the WHI were not taking HRT for this reason.
"So are women experiencing severe menopausal symptoms the same as the women who enrolled in the WHI? I don't think so," Jungheim tells WebMD. "And the estrogen prescribed today may be different than the Premarin used in the WHI. It is hard to inform patients based on this data."
LaCroix disagrees, and notes that there never will be large-scale clinical trials of modern forms of HRT.
"All we can say is the best evidence on HRT comes from this large trial," she says. "We got very reassuring data for women in their 50s who can take estrogen-only HRT. I don't have any evidence that 'more natural forms' of estrogen are safer or have different risk profiles. They must be assumed equal unless there is new evidence."
While LaCroix and Jungheim disagree strongly about the relevance of the WHI findings, they agree that women facing severe menopausal symptoms should have a long, frank talk with their doctors.
"Every woman has to make her own choices," LaCroix says. "If you are having bothersome menopausal symptoms, you have some options."
"This is an opportunity for women to sit down with their doctors and be honest about the menopausal symptoms they are experiencing, and for these doctors and patients to come up with a plan so the woman is functioning at her best," Jungheim says. "That plan will vary from woman to woman depending on what her risk factors are for something else later on in life, and on what she has already tried and is eligible to try based on her risk profiles."