HRT - Epilogue
There is currently some objection to the application of the results of WHI, concerning the absence of benefits to CHD for women using hormone replacement therapy. In a "Bulletin of the American Society of Reproductive Medicine", ( v 6, number 32, June 23, 2004) they state that WHI did not include a sufficent number of subjects in the relevant age range to determine the impact of HRT on CHD. The majority of women in WHI were in their 60's and 70's, whereas only 574 women were in the more relevant 50 to 54 age group. Given the small number of participants, it was impossible to determine the impact of HRT on this particular group. They conclude that more randomized trials are needed to resolve this question. They do not, of course, offer an opinion as to whether HRT would indeed help prevent cardiovascular diseases. Nor do they provide any argument to counter the results showing other detrimental effects of HRT.
Update - 3 April, 2005
A recent National Institute of Health panel report discusses "Management of Menopause-Related Symptoms". The report discusses the possiblity of using reduced-dose hormones to deal with hot flashes and night sweats. It states that experts theorize that long-term adverse effects will be lower with these doses, but the exact risks and benefits are not known. The report states that "risk-benefit analyses are important for women whose ... symptoms are severe and create a burden on daily life". In other words, if you are having severe menopausal symptoms, don't discount the use of HRT, especially at low-doses, without a complete risk analysis.
Update - 31 January, 2006
The debate concerning the conclusions of the WHI results is still ongoing. The central issue is that in the WHI, many of the participants started taking hormones long after menopause set in. Possibly, heart disease developed during and after menopause, before starting HRT. In that case, HRT would not reverse heart disease that has already progressed; rather, the tendency of blood to clot would be enhanced by the therapy, leading to more heart problems. An article published in the Journal of Women's Health (V 15, p 35, 2006) examines this possibility. They attempted to determine whether the length of time between menopause and the start of HRT influences the risk of getting CHD. They find that if women start HRT near menopause, they reduce the risk of CHD (Risk Ratio of 0.66, with a Margin of Error between 0.54 and 0.80 for estrogen alone, Risk Ratio of 0.72 with a Margin of Error between 0.56 and 0.92 for estrogen with progestin). This study strongly suggests that HRT started at menopause is not detrimental to cardiac health, and may be beneficial. Personally, we believe that it will take several more years of study before this issue is resolved.