In the late 1990s, the United States began to studyHormone Replacement Therapy (HRT) and its effects on postmenopausal symptoms. The initial results of these clinical trials were published in 2002 as part of the Women’s Health Initiative and indicated several risks associated with hormone therapy.
This data helped shape the foundation of women’s healthcare and the treatments they receive. But when comparing the information to more recent studies, it's clear that there were significant flaws in the original research and HRT ultimately has several benefits.
See the HRT study debunked below.
While the 2002 HRT study aimed to accurately assess the risks versus benefits of hormone therapy for postmenopausal women, it ultimately fell short of its goal for a multitude of reasons:
Despite the limitations of the study, its results came as a shock to the field of women’s healthcare. Many physicians and women dropped HRT regardless of its efficacy or benefits due to the shifting public opinion about the safety of hormone therapy.
The sudden decrease in HRT use following the publication of the WHI study should have resulted in a significant and measurable improvement in women's health, but this wasn't observed.
For example, in northern California, HRT use dropped by68%, but breast cancer rates only declined by 10%. In Germany, HRT use decreased by 50%, yet breast cancer rates dipped about 8%. And Spain, Italy, and the Netherlands saw no decline in breast cancer rates following the decrease in HRT therapy.
Despite the low use of HRT, breast cancer rates didn’t stay down. By 2012, the number of women diagnosed had climbed to pre-2002 levels, leaving researchers questioning why. If the rates of women receiving hormone therapy had not increased, then the initial decrease in cancer rates following HRT reduction can likely be explained by other influential factors.
Let’s take a closer look at some of the myths surrounding hormone replacement and dispel the common misconceptions that both patients and physicians often have about HRT:
When reanalyzing the WHI study data after accounting for patient age, researchers found that coronary artery disease and overall mortality rates were decreased in women who received HRT within 10 years of beginning menopause.
Data collected from the Danish Osteoporosis Prevention Study backs these findings, indicating that hormone replacement therapy reduced the incidence of cardiovascular disease by52%.
Since the WHI study was conducted largely on older women well into menopause, it can be reasonably concluded that the increased risk of heart disease previously associated with HRT is related more to starting therapy at a later age than it is receiving therapy at all.
Recent research has confirmed that there is a slightly elevated risk of blood clots with oral HRT, however, this increase is usually small and can be mitigated by starting therapy at lower doses or using non-oral routes of delivery.
The original WHI study tested a combination of estrogen and medroxyprogesterone acetate (MPA), which was shown to increase the risk of breast cancer, but not the risk of mortality. However, more recent studies published in the Journal of the American Medical Association suggest that treatment with estrogen only substantially reduced both the risk of breast cancer and mortality.
The Danish Osteoporosis Prevention Study also revealed that, contrary to popular belief, hormone replacement therapy wasnot associated with clinically significantweight gain. The data suggested that primarily, weight gain among participants was determined by a lack of exercise combined with natural weight gain that occurs after menopause.
While hormone replacement is usually necessary for women experiencing severe symptoms of menopause, it can also be highly beneficial for those who only have mild issues. This includes bothersome but not debilitating problems like hot flashes, night sweats, mood changes, insomnia, and more.
According to the U.S. Office on Women's Health, approximately5% of women naturally experience early menopause. However, it's a common misconception that they should avoid hormone replacement until they are over the age of 45.
Menopause occurs because the ovaries no longer have the ability to produce enough estrogen and when this occurs early on, women will have a higher risk of health conditions associated with hormone loss until they reach the age at which their body would normally stop producing it. This means considering HRT is crucial for women with early menopause symptoms or who have had a hysterectomy.
Medical technology has come a long way in the decades since these original studies were published. There are multiple routes of delivery, including patches, gels, injections, and convenientpellet implants that last up to 6 months.
It’s also a myth that there is only one type of hormone available for treatment. Newer treatments can be formulated with different balances of estrogen, progesterone, and sometimes testosterone to achieve specific desired effects, such as the reduction of hot flashes.
Today, HRT is generally regarded as the “gold standard” for postmenopausal women’s health. Patients who receive hormone therapy early on and continue for the recommended period of time not only experience a reduction in troublesome symptoms, but also enjoy a lower risk of serious complications.
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