253 ‒ Hormone replacement therapy and the Women’s Health Initiative: re-examining the results

Summary

In this podcast episode, the speakers discuss the Women's Health Initiative (WHI) study and its impact on the public perception of hormone replacement therapy (HRT). They delve into the increased risk of breast cancer with estrogen plus progestin and the surprising finding that estrogen alone did not increase breast cancer risk.

The WHI was designed to test the use of hormone therapy for the prevention of chronic diseases in postmenopausal women, including heart disease and cognitive decline. The study produced some unexpected results that have since contributed to misconceptions surrounding HRT, such as the belief that the therapy causes breast cancer. The speakers emphasize the importance of understanding the distinction between relative risk and absolute risk and encourage a nuanced and individualized approach to HRT decision-making.

They also discuss the use of hormone therapy for treating symptoms like hot flashes and night sweats in recently menopausal women, highlighting the importance of considering individual risks and benefits. As an alternative for those not suitable for HRT, non-hormonal options like antidepressants can be considered.

Furthermore, the long-term effects of hormone therapy in reducing fractures and mortality rates are discussed, but the study cannot conclusively determine whether significant benefits are obtained in these areas from long-term HRT usage. The trend towards using FDA-approved bioidentical formulations like transdermal estradiol and micronized progesterone is seen as positive, but more randomized trials are needed to understand their long-term benefits and risks.

The speakers conclude that younger women in early menopause with severe symptoms should seek help and consider hormone therapy, as the benefits are likely to outweigh the risks. They also mention the North American Menopause Society's website as a useful resource for finding certified menopause practitioners. Lastly, the episode acknowledges the "lost generation" of women who suffered unnecessarily due to misinformation surrounding the WHI study and hormone therapy.