Menopausal Hormone Therapy . . . Current Concepts (cont.)

There are 2 ways to think about decision-making regarding hormone therapy (HT). In general terms, we can group the "good things" together and the "bad things" together and compare them. The way scientists do this is to multiply the numbers of women by the number of years that they are taking the hormone therapy. This measure is called "person-years". In the WHI, the numbers of expected good things (protection against colorectal cancer and hip fracture, were less than the number of expected bad things (heart disease, stroke, blood clots in the lungs, and breast cancer) - specifically, 11 extra "good things" as compared to 31 extra "bad things" per 10,000 person-years for the women taking estrogen/progesterone therapy compared to taking placebo. For the women taking estrogen therapy, the corresponding numbers are 18 extra "good things" and 15 extra "bad things". Each individual woman will have a different opinion about whether the 31 extra "bad things" per 10,000 women taking estrogen/progesterone therapy for a year is enough to make her avoid hormone therapy. Because of this, the decision whether to initiate hormone therapy is a highly personal decision.

If this is too confusing, consider the following seven possible scenarios:

  1. A woman just recently becomes menopausal. She had her last menstrual period a year ago and is began taking CEE/MPA due to bothersome hot flashes. What should she do with the CEE/MPA she is taking?

If she is at otherwise low risk for stroke, heart disease, or blood clots (which she will determine with her physician), she can consider continuing her CEE/MPA to control her hot flashes. Although this is a highly personal decision, the otherwise healthy woman who takes the hormone therapy for a short-term period (fewer than 4 or 5 years) to relieve hot flashes is in fact currently the best candidate for hormone therapy. The "risk and benefit" is likely to be in her favor because she is otherwise healthy, she will only use the hormone therapy for a short period, and hormone therapy is an the most effective therapy (the only FDA-approved therapy) for reducing hot flashes.

  1. A woman has been taking hormone therapy for 2 years due to hot flashes, but a different hormone preparation, not CEE/MPA. She wants to know how to apply the results of the WHI in her own case.

The WHI did not include any preparation other than CEE/MPA. Therefore, we cannot make firm conclusions. It is probably reasonable to say that similar overall risks and benefits apply as in the woman in example 1 above. Again, each women has to carefully consider her individual health profile and balance of risk versus benefit, optimally with her physician. If her overall health is good (no particular risk of heart disease, stroke, blood clots, or breast cancer prior to starting therapy); if she is going to use the therapy for only a few years; and if her hot flashes are bothersome enough that she wants to take therapy; she can reasonably opt to continue the therapy with an generally low risk of complication. Again, as mentioned above, each individual woman has to decide what level is increased risk is "acceptable."

  1. A woman has been taking hormone therapy for 8 years. She feels great and is afraid of stopping because her mother has terrible osteoporosis. She needs to know what to do about her family history of osteoporosis. Her mother had a hip fracture.