Thoughts on the WHI Study on HRT

by Paulette Avery, R.N., M.S.N.

Judging by the number of calls we're receiving in OB/GYN Advice at Kaiser Oakland, there is a great deal of interest, concern, and confusion about the recently released results from the Women's Health Initiative (WHI) study on hormone replacement therapy (HRT). So I'll pass on the advice Kaiser Permanente doctors are giving to their patients, and add some additional information I hope will help any of you who are deciding what to do about HRT.

The WHI study, conducted by the National Institutes of Health, began in 1993 to look at the effects of taking hormones to replace those lost when a woman enters menopause. Many consider this study very important, as it set out to find whether taking estrogen and progesterone truly protect women from heart disease and osteoporosis, as has been believed, in addition to helping eliminate symptoms such as hot flashes. On July 9, the researchers halted the part of the study looking at women who take both estrogen and progestin because results show a small, but significant increase in heart attacks, strokes, and breast cancer among women who have been taking the combination of hormones for more than five years. As a side note, both hormones are recommended when a woman still has her uterus, as taking estrogen alone has been shown to result in a higher risk of uterine cancer.

On a brighter note, the study found some benefits from using the combined hormones. Women who took both hormones had less colon cancer and fewer hip fractures. But the researchers felt these benefits were not enough to make up for the potential harm.

So what does this all mean? The first thing I want to point out is that according to Dr. Susan Lark, who speaks at Stanford annually on the topic of menopause, only about 10 percent of menopausal women are taking conventional HRT. The other 90 percent choose not to for a variety of reasons, including undesirable side effects, fear of problems caused by long-term use of the hormones, or the desire to handle menopause in a more natural manner, either by using nothing at all or by using alternative treatments such as diet and supplements.

Based on the study results, doctors at Kaiser recommend that their patients who have been taking estrogen and progesterone for five years or more consider stopping. The decision is not urgent. You can take time to think about why you decided to use the hormones and whether, with this new information, you want to continue. If you choose to stop, I recommend talking with your health care provider about your individual situation and how to stop. However, Kaiser doctors say their patients can safely stop the hormones on their own.

If you have had a hysterectomy and take just estrogen, to date the WHI study has found no reason to stop. That portion of the study will continue. It is also considered safe to use estrogen and progesterone for one to three years to treat the symptoms of menopause, such as hot flashes, insomnia, etc. There are also no findings that indicate a problem with using estrogen cream to treat vaginal dryness. The use of estrogen patches in conjunction with progesterone has not been studied, but could potentially have the same risks identified in the study.

This is a complex subject with many considerations to factor into your decision. For some women, the study findings are enough that they decide to quit immediately. For others, the choice is less clear. If the decision is not an easy one for you, do more research and talk to your doctor. I also recommend the following resources for further information:

A book, The Wisdom of Menopause: Creating Physical and Emotional Health and Healing During the Change, by Christiane Northrup, M.D.

Web sites www.whi.org, www.menopause.org, and www.drlark.com.

Paulette Avery is a registered nurse and a freelance writer specializing in health issues.