Menopausal Hormone Therapy . . . Current Concepts (cont.)
The WHI did not specifically address the effects of hormone therapy on heart disease in women who already had heart disease. However, pre-WHI studies specifically carried out in women with known heart disease had already provided unequivocal proof that hormone therapy does not protect against, and may actually increase risk of, heart disease recurrence in women who already have coronary heart disease. Neither CEE/MPA nor CEE alone should be continued long-term for the purpose of treating heart disease. In this case, The hormones may actually be increasing her cardiac risk, and possibly increasing breast cancer risk. Most experts would recommend that she stop the hormone therapy. Again, the irony is that the hormone therapy was probably doing a good job at preventing her from osteoporosis-related fractures, as proven by the WHI. A different osteoporosis medication would have to be substituted in place of the hormone therapy.
How should a woman stop hormone therapy? There is not a strict guideline, nor is there any reliable clinical study, telling physicians how to discontinue hormone therapy, however, it is clear that many woman have temporary unpleasant symptoms with stopping the hormones suddenly. Most menopause experts currently recommend that women "taper" or "wean" hormone therapy.
Each woman will have to continue speaking with her physician face-to-face in a calm and thoughtful way, so she can make the decision that is right for her. Different women will continue to come to different conclusions depending on their individual circumstances.
It is comforting to have a well-done large and comprehensive research study available for reference. The WHI was long overdue and necessary. Although the WHI confirmed many things we had already suspected, its new findings and the findings of prior studies can help guide womens' decisions about hormone therapy. The decisions are difficult and will likely remain difficult for the next several years.
One more word of caution: It is critical to remember that people who do not conduct research may report study results accurately, but they are usually not able to accurately report the quality of a study, or how a study should fit into the actual day-to-day health of women. Fortunately, in the case of the WHI, the study was very well performed, but in general, women would do well to discuss any worries they have regarding media reports with a caring physician who feels qualified to discuss the quality of the research. Often a woman will be relieved to know the research may not even apply to her particular health concerns.
For information about "HT" and "ET," please read Dr. Crandall's Doctor's View, "HT/ET, Making Sense of It!"
Last Editorial Review: 8/24/2005