Are there second thoughts about the results of the WHI study?
The publication of the Women's Health Initiative (WHI) study had significant impact on the attitude of physicians and patients towards the use of hormones in the menopause. It has been estimated that 40-83% of patients using hormones ceased treatment on their own initiative following publication of the WHI results. While in the pre-WHI period, use of hormones in the menopause was termed 'hormone-replacement therapy' (HRT) with an emphasis on replacement; 'HRT' has now been replaced with the term 'hormone therapy' (HT), focusing on the therapy's status as a treatment with defined risks and benefits. Following the publication of the WHI study, many caregivers concluded that HT had absolutely no role in clinical practice. However, the decision to begin HT for the symptomatic, healthy, newly postmenopausal woman should be based on whether the WHI study addresses all the issues that must be taken into consideration before initiation of HT, whether there are effective alternatives available to relieve climacteric symptoms, and also whether HT is better able to prevent cardiovascular disease (CVD) and Alzheimer's disease (AD) than to halt atherosclerotic lesions. Every postmenopausal woman should have an individual risk-benefit evaluation to determine whether HT suits her needs. Until the effectiveness of HT for primary prevention of CVD and AD is established or disproved, there is no justification for HT use in the asymptomatic postmenopausal woman. However, symptomatic newly menopausal women might experience relief of their climacteric symptoms following HT use without exposing themselves to unreasonable risks.
Haimov-Kochman
Ronit
R
Department of Obstetrics and Gynecology, Hadassah University Medical Center, Mt Scopus, Jerusalem. Israel.
Hochner-Celnikier
Drorith
D
D000544:Alzheimer Disease / Q000517:prevention & control; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003071:Cognition / Q000187:drug effects; D003657:Decision Making; D005260:Female; D020249:Hormone Replacement Therapy / Q000009:adverse effects*; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D017698:Postmenopause; D012307:Risk Factors