Use caution when considering hormone therapy, Stanford WHI expert says

- By Susan Ipaktchian

The School of Medicine scientist who played a lead role in the landmark Women's Health Initiative says women should exercise caution in deciding whether to use hormone therapy to treat the symptoms of menopause.

Marcia Stefanick, PhD, professor of medicine at the Stanford Prevention Research Center, served as the chair of the WHI's steering committee for the duration of the trial and is now chair of the WHI Extension Study, which is continuing to follow participants through 2010. She said current guidelines from the U.S. Food and Drug Administration indicate three primary reasons to consider taking menopausal hormone therapy:

  • To relieve moderate to severe hot flashes.
  • To relieve vaginal dryness.
  • To prevent osteoporosis in women with several risk factors for the disease.

'For women who initiate hormone therapy, they should use the lowest possible dose to relieve their symptoms and use it only for the shortest amount of time necessary,' Stefanick said. She added that estrogen is still the best available treatment for hot flashes and night sweats, and noted that a topical estrogen (not oral or a skin patch) is recommended for vaginal problems.

Stefanick

Prior to WHI's landmark 2002 findings, observational studies suggested that hormone therapy offered women protection against heart disease. Physicians often urged women to take hormones for years as a preventive measure, in addition to the medication's intended use of easing menopausal symptoms.

But the 2002 findings changed all of that. The WHI study found that the combination of estrogen and progestin increased the risk of breast cancer, heart disease, stroke and blood clots. It also demonstrated that these risks outweighed the benefits of reducing bone fractures and possibly lowering colon cancer risk. Later WHI findings indicated that the risk of developing memory loss increased among older women using hormones.

'After the study was published, the FDA ordered 'black-box' labeling on estrogen products, saying that hormone therapy should not be used to prevent heart disease,' Stefanick said.

She also noted that although estrogen does prevent bone loss, the FDA recommends that women first consider non-estrogen alternatives, such as Fosamax or Boniva. She added, 'Estrogen is for osteoporosis prevention only; it is not FDA-approved as a treatment if a woman has already been diagnosed with osteoporosis.'

Further examinations of the WHI data published this year indicate that older women and those who initiate hormones 20 or more years after menopause face the greatest potential heart health risks, while those who use it closer to the onset of menopause fare better.

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2023 ISSUE 3

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