News & Science

Younger Women Misinterpret Risks of HRT, Forgo Benefits

Fear continues to keep symptomatic women from being offered, or using, hormone therapy 

 

Following the WHI study (Women's Health Initiative), published in 2002, the use of Hormone Replacement Therapy (HRT) by women for menopausal symptoms dropped dramatically.  In a commentary on a recently published study the North American Menopause Society (NAMS) states that, “…new findings underscore the continued misinterpretation of the WHI study by patients and healthcare providers alike”, and, "Further analysis of the WHI has shown hormone therapy to be safe and effective for menopausal women who have bothersome hot flashes, night sweats, or sleep disruption if they start hormone therapy while aged younger than 60 or within 10 years of menopause.” Importantly, NAMS concludes: "Unfortunately, fear continues to keep symptomatic women from being offered, or using, hormone therapy.”

Younger Women Misinterpret Risks of HRT, Forgo Benefits - Medscape - Jan 14, 2019

 

Menopausal hormone therapy trends before versus after 2002 - impact of the Women´Women’s Health Initiative Study Results.  Crawford, S.L. et al, Menopause, December 21, 2018

 

Comment:  When the press first reported the erroneous conclusions of the WHI — i.e., that HRT was harmful — millions of women were abruptly taken off HRT. Since then, fewer women have started treatment with HRT, which means unnecessary suffering for women with menopausal problems.  When patients were followed for a longer time and by using correct statistical methods, the results of the same WHI study show, in fact, that HRT is an extremely safe form of treatment.  In publications and press releases, the major gynecological scientific societies have tried to correct the damage caused by the first misleading reports.  The position of CCC is that women should make their own decisions about whether HRT is right for them based on the correct scientific evidence, which, unfortunately, is still overlooked by many, if not most, health professionals.

Recommendations & Benefits of HRT

The British Menopause Society outlines benefits of HRT

The British Menopause Society states in the 2013 Guidelines:

1: When prescribed to women younger than 60 years, HRT has a favorable benefit/risk profile.

2: If menopausal symptoms persist, the benefits of HRT usually outweigh the risks. Therefore, the duration of HRT usage should not be subject to arbitrary limits.

(New Guidelines From the British Menopause Society ‏. Medscape. May 24, 2013)

 

Comment:  Little doubt should remain about both the obvious benefits to women with menopausal symptoms treated with HRT, and that the risks are negligible, as summarised by this well renowned medical society.  Also, the notion that treatment must be limited to the "shortest time" possible is not validated.  As long as the benefits result in a marked improvement in quality of life, treatment can go on with proper monitoring.

Positive Cardiovascular Effects of Testosterone Treatment

Normalisation of Testosterone Level is Associated With Reduced Incidence of Myocardial Infarction and Mortality in Men

In this very large study (an observational cohort study) of testosterone treatment, 83010 men were divided in three groups: 1: un-treated, 2: insufficiently treated, and 3: sufficiently treated to normal levels of testosterone.  In group 3 where a normalisation of testosterone levels was reached there was a significant reduction in all-cause mortality, myocardial infarction, and stroke compared with the two other groups.

(Sharma, R et al. Eur. Heart J, 2015, 36, 2706-2015)

 

Comment:  Although controversies over the impact of testosterone on the cardiovascular system still exist, this very large study on the effect of actual treatment confirms the results of many smaller studies that show an overall benefit of testosterone treatment on these key outcomes: myocardial infarction, stroke and overall mortality.  The total mortality rate alone was reduced by 56% (Hazard ratio (HR): 0.44, confidence interval CI: 0.42-0.46).  The study emphasises that the positive effects show up almost exclusively in the treated group that reaches sufficient levels of testosterone.

 

HRT protects against age-related changes of the heart

Menopausal Hormone Treatment Shows Positive Effect on Heart Structure

Extracting data form the UK Biobank a large British study looked at the impact of hormone therapy on the heart in menopausal women.  Treated for an average of 8 years specific structures of the heart muscle stayed healthier than in the untreated group. The structural

components studied are considered strong markers of cardiovascular disease.

(Sanghvi MM, et al. PLOS ONE, March 8, 2018)

Comment:  The authors have made statistical analysis that compensate for the often cited "healthy user bias".  This is a factor that may skew results in favour of treatment due to the fact that women who are generally healthier and have a higher level of education may choose hormone treatment more often than less healthy subjects.  This gives strong validity to the conclusions of this study and supports the use of HRT to reduce the risk of menopausal women developing cardiovascular disease (CVD).  More on HRT and CVD