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Update on Timing of Hormone Replacement Therapy in Menopause

Update on Timing of Hormone Replacement Therapy in Menopause

In 1964, Dr. Robert Wilson, a gynecologist in New York City, advocated in his book Feminine Forever that all menopausal women should receive hormone replacement therapy (HRT).  The outrage of the feminist movement led the National Institutes of Health (NIH) to fund the Women’s Health Initiative (WHI) in 1991 to determine if HRT could safely protect women’s cardiovascular and bone health.  In July 2002, the trial was prematurely canceled due to findings of a statistical increase in both breast cancer and stroke.  Based on these findings and the resultant publicity, millions of women stopped their HRT, and doctors stopped prescribing HRT.  As a result of this precipitous change, the majority of menopausal women have gone without HRT for more than a decade.

Was The Women's Health Initiative Good Or Bad For Women's Health?

Was The Women's Health Initiative Good Or Bad For Women's Health?

Most women are familiar with the Women’s Health Initiative (WHI), the largest randomized controlled trial to date, sponsored by the National Institute of Health (NIH) to evaluate the role of hormone therapy in menopause to protect cardiovascular and bone health. Begun in 1991 as a proposed 15‐year study, women in menopause with a uterus were randomized to take orally either a placebo or PremPro®, a combination of Premarin®, a conjugated equine estrogen (CEE), and medroxyprogesterone, a synthetic version of progesterone. Women with a hysterectomy were given either CEE alone or placebo. In part, this $725 million study was intended to resolve the controversy over whether menopause should be embraced as a natural transition in life, a position taken by the feminist movement at the time, or, as proposed by such books as Feminine Forever (Pocket Books, NY, 1968), that menopause was a hormone deficiency totally preventable with hormone therapy.

The Pill Or The Patch? Are All Estrogens The Same?

The Pill Or The Patch? Are All Estrogens The Same?

Picture this scenario. You are 55 years old, three years into menopause, with hot flashes, mood swings, and vaginal dryness and pain on intercourse. Your care provider suggests hormone replacement therapy (HRT). However, he recalls that in 2002, the Women’s Health Initiative (WHI) reported that of 10,000 women‐years, HRT produced 18 more women with blood clots, eight more with stroke, and seven more with heart attacks than those not on hormones. You have a family history of blood clots. You hesitate; is this for you?

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