“No link between hormone therapy and all-cause or cause-specific death rates in the
Women’s Health Initiative
Those of us who have practiced gynecology as long as I remember very well the day that the Women’s Health Initiative (WHI) results were made public. It was July, 2002, and the news was unexpected. The Women’s Health Initiative was a study started in 1994 to determine if hormone therapy (given as conjugated equine estrogen and medroxyprogesterone acetate) would prevent cardiovascular disease in women between the ages of 50-80. Previous data were consistent with cardiovascular benefits for women who took hormones, so this study was initially hopeful. Instead, the initial data demonstrated that there were more heart attacks, strokes, blood clots, and breast cancer in women on the therapy. There were less osteoporotic fractures and colon cancer, but the risks outweighed the benefits. That day, many women stopped hormones and chose to tolerate their menopausal symptoms, rather than accept these additional risks.
In the last 15 years, the researchers have continued to collect data, and stratified the results related to age. Women in their 50’s had fewer risks than women in their 70’s. In the last 15 years, there has been broader use of transdermal estrogen and bioidentical progesterone, which may have a different safety profile. Many years later, researchers compared mortality statistics for women who took hormones in the WHI, vs. women who were taking placebo.
The study reported today in the Journal of the American Medical Association, looked at mortality rates for women who participated in the WHI.
Among 27,000 women who were randomized to hormones or placebo who on average took hormones for 5-7 years, and were followed up for 18 more years, the mortality rates were statistically equivalent. This included mortality for all causes, including heart disease and cancer.
Although it is not recommended that women take hormones to prevent chronic diseases, this data suggests that if women choose to take hormones to help them through the menopausal transition, long-term mortality rate is not affected. This is good news!
A decision to take hormone therapy is an individual decision made by a women and her physician, taking into account her medical history, physical findings, and family history.
Marilyn Jerome, MD
Foxhall OB-Gyn Associates
JAMA, 2017: 318 (10), 927-938
Menopausal Hormone Therapy and Long-Term All-Cause and Cause-Specific Mortality,
The Women’s Health Initiative Randomized Trials, JoAnn Manson, MD, DrPH, Aaron K. Aragaki,MS, Jacques E. Rossouw, MD, et al