In 2002, when results of the Women's Health Initiative (WHI) randomised controlled trial of hormone replacement therapy (HRT) showed an increased occurrence of breast cancer and thromboembolism, up to two-thirds of women taking HRT stopped the therapy, often without medical consultation.
Recent analyses of the WHI data and other randomised controlled trials suggest that, although there are potential side effects and risks involved in taking HRT, these may be reduced by:
When HRT is initiated near menopause for symptom control, there may be additional benefits (reduced fracture and cardiovascular risk) that outweigh the risks (which are not significantly raised in women under age 60 years).
Older women with continuing symptoms should not be denied HRT if their therapy and risks are assessed on an individual basis and each patient is aware of the risks.
- 1. National Health and Medical Research Council. A guide to the development, evaluation and implementation of clinical practice guidelines. Canberra: NHMRC, 1999. http://www.nhmrc.gov.au/publications/synopses/_files/cp30.pdf (accessed May 2007).
- 2. Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results from the Women’s Health Initiative randomised controlled trial. JAMA 2002; 288: 321-333.
- 3. MacLennan AH, Taylor AW, Wilson DH. Hormone therapy use after the Women’s Health Initiative. Climacteric 2004; 7: 138-142.
- 4. Sturdee DW, MacLennan AH. Should epidemiology, the media and quangos determine clinical practice? Climacteric 2004; 7: 1-2.
- 5. Phillips LS, Langer RD. Postmenopausal hormone therapy: critical reappraisal and a unified hypothesis. Fertil Steril 2005; 83: 558-566.
- 6. Grodstein F, Manson JE, Stampfer MJ. Hormone therapy and coronary heart disease: the role of time since menopause and age at hormone initiation. J Womens Health (Larchmt) 2006; 15: 35-44.
- 7. MacLennan AH, Sturdee DW. Long-term trials of HRT for cardioprotection — is this as good as it gets? Climacteric 2007; 10: 1-4.
- 8. Salpeter SR, Walsh JME, Greyber E, Salpeter EE. Coronary heart disease events associated with hormone therapy in younger and older women. J Gen Intern Med 2006; 21: 363-366.
- 9. Salpeter SR, Walsh ME, Greyber E, et al. Mortality associated with hormone therapy in younger and older women. J Gen Intern Med 2004; 19: 791-804.
- 10. Rossouw JE, Prentice RL, Manson JE, et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA 2007; 297: 1465-1477.
- 11. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer. Lancet 1997; 350: 1047-1059.
- 12. Greiser CM, Greiser EM, Doren M. Menopausal hormone therapy and risk of breast cancer. A meta-analysis of epidemiological studies and randomized controlled trials. Hum Reprod Update 2005; 11: 561-573.
- 13. Collins JA, Blake JM, Crosignani PG. Breast cancer risk with post menopausal hormonal treatment. Hum Reprod Update 2005; 11: 545-560.
- 14. Norman RJ, MacLennan AH. Current status of hormone therapy and breast cancer. Hum Reprod Update 2005; 11: 541-543.
- 15. Million Women Study Collaborators. Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet 2003; 362: 419-427.
- 16. Singletary SE. Rating the risk factors for breast cancer. Ann Surg 2003; 237: 474-482.
- 17. Anderson GL, Chlebowski RT, Rossouw JE, et al. Prior hormone therapy and breast cancer risk in the Women’s Health Initiative randomized trial of estrogen plus progestin. Maturitas 2006; 55: 103-115.
- 18. Women’s Health Initiative Steering Committee. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy. The Women’s Health Initiative Randomised Controlled Trial. JAMA 2004; 291: 1701-1712.
- 19. Chen WY, Manson JA, Hankinson SE, et al. Unopposed estrogen therapy and the risk of invasive breast cancer. Arch Intern Med 2006; 166: 1027-1032.
- 20. Cushman M, Kuller LH, Prentice R, et al, for the Women’s Health Initiative Investigators. Estrogen plus progestin and risk of venous thrombosis. JAMA 2004; 292: 1573-1580.
- 21. Canonico M, Oger E, Plu-Bureau G, et al. Hormone therapy and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration and progestogens: the ESTHER study. Circulation 2007; 115: 840-842.
- 22. Sturdee DW, MacLennan AH. Prevention of osteoporosis is still a valid aim for hormone therapy. Climacteric 2005; 8: 97-98.
- 23. The North American Menopause Society. Estrogen and progestogen use in peri- and postmenopausal women: March 2007 position statement. Menopause 2007; 14: 168-182.
- 24. MacLennan AH, Henderson VW, Paine BJ, et al. Hormone therapy, timing of initiation, and cognition in women older than 60 years: the REMEMBER pilot study. Menopause 2006; 13: 28-36.
- 25. Schumaker SA, Legault C, Kuller L, et al. Conjugated equine estrogens and incidence of probable dementia and mild cognitive impairment in postmenopausal women. Women’s Health Initiative Memory Study. JAMA 2004; 291: 2947-2958.
- 26. Zandi PP, Carlson MC, Plassman BL, et al, for the Cache County Memory Study Investigators. Hormone replacement therapy and incidence of Alzheimer disease in older women. JAMA 2002; 288: 2123-2129.
- 27. Clark JH. A critique of Women’s Health Initiative Studies (2002-2006). Nucl Recept Signal 2006; 4: e023.
- 28. La Vecchia C. Estrogen-progestogen replacement therapy and ovarian cancer: an update. Eur J Cancer Prev 2006; 15: 490-492.
- 29. Million Women Study Collaborators. Ovarian cancer and hormone replacement therapy in the Million Women Study. Lancet 2007; DOI:10.1016/S0140-6736(07)60534-0. (Published online Aril 19.)
- 30. MacLennan AH, Broadbent JL, Lester S, Moore V. Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. Cochrane Database Syst Rev 2004; (4): CD002978.
- 31. Suckling J, Lethaby A, Kennedy R. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev 2006; (4): CD001500.
- 32. MacLennan AH, Myers SP, Taylor AW. The continuing use of complementary and alternative medicine in South Australia: costs and beliefs in 2004. Med J Aust 2006; 184: 27-31.
- 33. Nedrow A, Miller J, Walker M, et al. Complementary and alternative therapies for the management of menopausal symptoms. A systematic evidence review. Arch Intern Med 2006; 166: 1453-1465.
- 34. Stearns V. Serotonergic agents as an alternative to hormonal therapy for the treatment of menopausal symptoms. Treat Endocrinol 2006; 5: 83-87.
- 35. MacLennan AH, Sturdee DW. The “bioidentical/bioequivalent” hormone scam. Climacteric 2006; 9: 1-3.
- 36. Kenemans P, Speroff L. Tibolone: clinical recommendations and practical guidelines. A report of the International Tibolone Consensus Group. Maturitas 2005; 51: 21-28.
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