Tuesday, February 19, 2008


Five years ago, the NIH stunned the country by publishing a study regarding hormone replacement therapy (HRT). This study refuted ALL the previous studies heralding the benefits of HRT, by claiming that it increased the incidents of heart disease and breast cancer. This sensationalized conclusion led millions of women to abandon their HRT, leading to mass suffering among women. I remember seeing these headlines in very well placed articles in various newspapers. It aggravated me because I reviewed their data and found one serious flaw that should have negated all their results: their data was NOT STATISTICALLY SIGNIFICANT.

Whenever scientific studies are performed, their results are measured by various mathematical tests to see if in fact the findings are really showing what they purport to show. We call this statistical significance. Results are either statistically significant or not. There is no middle ground. The WHI authors tried to create a new term, "almost statistically significant." There is no almost. It is either yes or no. If it is not yes, then the results are not justified. Since the release of this study, multiple newer analyses of the same data have refuted the author's original claims. In addition, the average age of women in the study was 60 and a full 10 years after starting menopause. The conclusion that readers should draw, after all the recent backpedaling, is that the findings of this study from 5 years ago were incorrect and should be ignored. They also don't apply to recently menopausal or perimenopausal women.

So what do you do now?
  • If a woman is postmenopausal and does not take HRT for 10 years or more after menopause, then there will be no benefit to starting. In fact, estrogen could be detrimental at that point. However, several recent studies and re-analysis of WHI data have shown, in confirmation of previous pre-WHI studies, that HRT is beneficial to women if begun at or near menopause.
  • Benefits include a reduction in heart disease, cognitive function, skin health, vaginal health and bone health.
  • Most significant, is a reduction in heart disease, which is the number one cause of death in women after menopause.
  • In addition, the review of the data, contrary to the original WHI conclusions, is that there is a reduction in the incidence of breast and colon cancer. The studies are too numerous for me to cite here, but suffice it to say that the data is overwhelming.

I have continued to recommend HRT in my peri-menopausal and menopausal patients, despite the initial WHI broadcasts. I'm glad I did because now we know that it is protective of their health. For me it only makes sense. The most healthy, happy and vigorous parts of a women's life is the pre-menopausal days when estrogen was abundant. When women become menopausal, their health, body and mind begin to deteriorate, as a result of the lack of estrogen. In fact, estrogen is the youth hormone and should be continued. When my patients present in their 40's with peri-menopausal symptoms of irregular or abnormal periods, insomnia, difficulty concentrating or remembering, mood swings, lack of energy or general lack of well-being, that is the time that I recommend HRT. Usually, I use a low-dose birth control pill because it has sufficient estrogen and is easy to take. In women who don't have a uterus (due to hysterectomy) I give a higher dose estrogen without progesterone. At this point, it is unknown how long a woman should take estrogen. In my opinion, since the average lifetime of women is increasing, currently it is 86 years old, women should continue with the estrogen indefinitely. At some point, maybe it won't be necessary but for now, I think there is very little risk and lots of youth to gain.

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