The Women’s Health Initiative (WHI) was launched in the early 1990s to study women’s health regarding cardiovascular and other diseases, cancer, and menopausal care. When the WHI’s published its research on hormone replacement therapy (HRT) in 2002, it was the largest of its kind. And indeed, the results were groundbreaking—in the worst way possible.
HRT was found to increase the risk of developing dementia, cancer and other diseases among menopausal women. HRT was declared taboo after scientists argued that the risks outweighed their benefits. Even after other researchers pointed out the study’s many flaws, the stigma has persisted for decades.
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The North American Menopause Society finally updated its guidelines 20 years later to correct the error. Here’s what you need to know (and what you need to unlearn).
What did The WHI do wrong?
Despite the WHI’s noble intentions, the results of the 2002 paperThere were many reasons why they were incorrect.
1. Participants were past menopause age
Dr. James H. Clark wrote a 2006 review. Publié in Nuclear Receptor Signaling, one predominant issue was the age of the study’s participants. Most of the thousands of women who took part in the study were over 50 years old. “12-15 years past the onset of menopause,”Clark wrote.
“Thus, these women were without their pre-menopausal levels of estrogen and progesterone long enough to bring about changes in various bodily functions, which are the precursors of disease.”
Bottom line: The women enrolled in the study were not representative for the general population of women who would normally be beginning an HRT regimen.
2. Participants were already at risk in excess
Dr. Peter Attia discusses his study on his YouTube channel. In which he refers to the WHI study “the biggest screw-up of the entire medical field in the last 25 years.”
Attia explains the time constraints for the study prevented scientists from using younger women, who they would have had to follow for longer than older women to determine menopause (and HRT’s) effects on the body later in life.
But Attia says the participants weren’t just older; they were sicker, too. “Something like 30, 40 percent of these women were smokers. The prevalence of obesity, diabetes was enormous. [The researchers] disproportionately picked the most unhealthy population they could.”
3. Comparing Absolute and Relative Risk
Clark also claims that the WHI inflated the corresponding disease incidence rates. Rather than using absolute risks, which provide a clearer picture of a population’s overall risk level, the study emphasized relative risks.
Risk ratios relativeFocusing on smaller groups will result in higher risk percentages. These larger (and more frightening) numbers were portrayed by the media as if there was a greater correlation between HRT with various diseases.
As Dr. Louann Brizendine Kristen Phillpkoski (Suggest editor) explains it, the WHI study set research in women’s hormone therapy back 20 years. “One of the things that happened is they stopped teaching [about it] in medical schools.”
“Even OBGYNs,”Brizendine remained. “many of them say they aren’t prepared to do hormone therapy for women. They didn’t get any more than one lecture during their residency in hormone therapy.”
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The AARPIt was reported that only 20% OBGYN residency programmes offer any menopausal education. Menopause training is provided by about four hours for those who receive it during medical school. Philip M. Sarrel (professor emeritus of Gynecology, Yale School of Medicine) Telled AARP, “doctors are not helpful. They haven’t had training, and they’re not up to date.”
HRT is Safe and Effective for Most Women, These are the Facts
It looks like this is starting to change. Published in: A 2022 Study CancerHRT significantly decreased all-cause mortality rates and cardiovascular disease in women under 60 years of age and those who were near or at menopause.
As Texas-based OBGYN Dr. Mary Claire Haver outlines on her YouTube channel, these findings suggest HRT can prevent or reduce the symptoms of many diseases women encounter during midlife including cardiovascular disease, osteoporosis, Alzheimer’s, and sexual and vaginal disorders.
Based on these findings, The North American Menopause Society has updated its guidelinesHRT. “Hormone therapy remains the most effective treatment for vasomotor symptoms [hot flashes, night sweats, etc.] and the genitourinary syndrome of menopause and has been shown to prevent bone loss and fracture,”The NAMS stated.
“For women younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio is favorable for treatment of bothersome VMS and prevention of bone loss. For women who initiate hormone therapy more than 10 years from menopause onset or older than 60, the benefit-risk ratio appears less favorable because of the greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia.”
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The NAMS statement acknowledges the WHI study’s findings, but it places them in the right context. HRT is safe and effective for most women under 60, as well as those who are nearing menopause.
What is your opinion about breast cancer?
The NAMS statement indicates that HRT is an effective treatment. MostThis does not apply to women. All women. The WHI is not perfect, but there are still some correlations between estrogen levels with breast and uterine cancer development.
Using estrogen Progestin, or combined hormone therapy, can help reduce the risk of estrogen-related breast cancers. The danger isn’t non-existent. The danger is not non-existent. American Cancer Society explains, “to put the risk into numbers, if 10,000 women took [HRT] for a year, it would result in up to about eight more cases of breast cancer per year than if they had not taken hormone therapy.”
The ACS is also available. Cites the HABITS clinical trialHRT has been proven to be effective in treating breast cancer. “were much more likely to develop a new or recurrent breast cancer than women who were not taking these hormones. Because of this, doctors generally do not recommend [HRT] if a woman was previously treated for breast cancer.”
What does this all mean?
HRT may not be right for everyone, despite the 2002 data. But as more accurate menopause information enters the mainstream, it’s likely that many women will discover that they are eligible for hormonal treatments (and that it could have enormous benefits on their overall well-being).
Ultimately, it’s a decision for you and your doctor to make, so it’s critical to find a doctor who observes the most up-to-date and factually accurate menopause guidelines. Dr. Haver and her staff are available to help you find a new healthcare provider. We have curated a list recommending physiciansAll over the USA, Puerto Rico and Canada, as well as the UK and South Africa.
Whatever route you choose in your midlife journey, let science—not fear—lead the way.