In a recent commentary on hormone replacement therapy (HRT),1 the authors began by saying that physicians have been prescribing hormones to women as a “wonder pill” without appropriate studies to fully evaluate the risks and benefits. They concluded by saying that the Women's Health Initiative (WHI) study tells us to avoid HRT as far as possible. Are the authors of the commentary not just as guilty of jumping to conclusions?
Granted, the WHI was well designed and well implemented. But what exactly does this study tell us? The WHI researchers have not stopped the arm of the study in which women who have had a hysterectomy are given estrogen only, so we might gather that this large group has not experienced an increase in heart disease, blood clots, strokes or breast cancer. This would lead us to conclude that medroxyprogesterone is the culprit, not estrogen and not necessarily the other very different progestins.
We have known for years that estrogen improves cholesterol levels2,3 and that medroxyprogesterone negates that benefit.4 The WHI has simply confirmed the negative effects of this one hormone preparation, nothing else. Hence, we should not jump to conclusions and condemn all other hormone preparations.
The risks and benefits of the other preparations remain to be painstakingly researched. Our menopausal patients expect nothing less.
Lianne Lacroix Glenmore Medical Clinic Kelowna, BC
Footnotes
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Competing interests: Dr. Lacroix receives speaker fees from an annual public speech on menopause sponsored by a pharmaceutical company. In making these presentations, she sponsors no products and follows the guidelines of the Society of Obstetricians and Gynaecologists of Canada.