title: Risks and benefits of hormone therapy: has medical dogma now been overturned?
abstract: BACKGROUND
  In an integrated overview of the benefits and risks of menopausal hormone therapy (HT), the Women's Health Initiative (WHI) investigators have claimed that their 'findings … do not support use of this therapy for chronic disease prevention'. In an accompanying editorial, it was claimed that 'the WHI overturned medical dogma regarding menopausal [HT]'.
  
  
  OBJECTIVE
  To evaluate those claims.
  
  
  METHODS
  Epidemiological criteria of causation were applied to the evidence.
  
  
  RESULTS
  A 'global index' purporting to summarize the overall benefit versus the risk of HT was not valid, and it was biased. For coronary heart disease, an increased risk in users of estrogen plus progestogen (E + P), previously reported by the WHI, was not confirmed. The WHI study did not establish that E+ P increases the risk of breast cancer; the findings suggest that unopposed estrogen therapy (ET) does not increase the risk, and may even reduce it. The findings for stroke and pulmonary embolism were compatible with an increased risk, and among E+ P users there were credible reductions in the risk of colorectal and endometrial cancer. For E+ P and ET users, there were credible reductions in the risk of hip fracture. Under 'worst case' and 'best case' assumptions, the changes in the incidence of the outcomes attributable to HT were minor.
  
  
  CONCLUSIONS
  Over-interpretation and misrepresentation of the WHI findings have damaged the health and well-being of menopausal women by convincing them and their health professionals that the risks of HT outweigh the benefits.
authors.affiliation: Department of Public Health and Family Medicine, University of Cape Town Medical School , Cape Town , South Africa.
authors.forename: S
authors.initials: S
authors.lastname: Shapiro
authors.forename: T J
authors.initials: TJ
authors.lastname: de Villiers
authors.forename: A
authors.initials: A
authors.lastname: Pines
authors.forename: D W
authors.initials: DW
authors.lastname: Sturdee
authors.forename: R J
authors.initials: RJ
authors.lastname: Baber
authors.forename: N
authors.initials: N
authors.lastname: Panay
authors.forename: J C
authors.initials: JC
authors.lastname: Stevenson
authors.forename: A O
authors.initials: AO
authors.lastname: Mueck
authors.forename: H G
authors.initials: HG
authors.lastname: Burger
mesh_terms: D015982:Bias; D001943:Breast Neoplasms / Q000139:chemically induced / Q000453:epidemiology*; D015986:Confounding Factors, Epidemiologic; D003327:Coronary Disease / Q000139:chemically induced / Q000453:epidemiology*; D003627:Data Interpretation, Statistical; D004967:Estrogens / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D006801:Humans; D008593:Menopause; D011372:Progestins / Q000009:adverse effects / Q000627:therapeutic use*; D018570:Risk Assessment
chemical_list: D004967:Estrogens; D011372:Progestins
keywords: BENEFIT; HORMONE THERAPY; RISK