A must read for those considering HRT

Posted: 05 May 2013

The Women’s Health Initiative (WHI) study was prematurely stopped in 2002 due to a reported increase in the incidence of breast cancer in women in the hormone replacement arm of the study. As a result, thousands of women have stopped, or been taken off their hormones unnecessarily. This has lead to needless confusion, suffering and fear, to the point of hysteria in some, regarding the use of hormone replacement therapy (HRT). Since then, many of the main findings of this study have been debunked, albeit with much less media attention.

Multiple studies have challenged the conclusions of WHI. One such study was published in the British Medical Journal and released October 9, 2012. The data came from the Danish Osteoporosis Prevention Study where recently postmenopausal women, ages 45- 58, were treated with or without HRT for 10 years. The original study was actually started in the early 1990s. Hormones were stopped at 10 years when the results of the Women’s Health Initiative (WHI) study were released in 2002, with follow up carried out until 2008. In the current report, the same data was analysed for cardiovascular outcomes, cancer and overall mortality.

In the Danish study, women who previously had a hysterectomy were given oral bioidentical estradiol. (Topical is now the preferred route) Women who still had a uterus were given a combination of oral estradiol and a synthetic progestin. (Bioidentical progesterone is now the preferred “progestin”)

Conclusions of the analysis were that “After 10 years of randomized treatment, women receiving hormone replacement therapy early after menopause had a significantly reduced risk of mortality, heart failure, or myocardial infarction (heart attack), without any apparent increase in risk of cancer, venous thromboembolism (blood clots), or stroke.” The mortality risk reduction was about 40%! They went on to state that “early initiation and prolonged hormone replacement therapy did not result in an increased risk of breast cancer or stroke.”

There was no significant difference in the incidence of breast cancer between those who took hormones and those who did not. In fact, women who started hormone therapy prior to age 50 had a significant decrease in the incidence of breast cancer.

What does this study tell us?

How can this be reconciled with the findings of the Women’s Health Initiative?

Take home message:


While some clinicians would consider it premature to recommend HRT for mortality reduction, it is increasingly clear that with appropriate patient selection, the use of bioidentical hormones given via the proper route of delivery, does not pose an increased risk of mortality or cancer, and may even decrease these risks.

Taken from an article written by Raymond Ishman MD CEO and Chief Medical Officer of Cenegenics - a leading anti-ageing clinic.

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