Researchers Seek to Demystify Hormone Therapy

JoAnn Manson, MD, MPH, DrPH, helps set the record straight about the safety and appropriate use of menopausal hormone therapy.

by Hannah Wool

“In the 1980s, menopausal hormone therapy [HT] was perceived as good for all women in treating symptoms of menopause and preventing heart disease and other chronic diseases,” says JoAnn Manson, MD, MPH, DrPH, scientific advisor of the Connors Center. “Then, in the early 2000s, hormone therapy became perceived as bad for all women. Now, I think the pendulum is resting in a much more appropriate place, which is that HT is appropriate for some, but not all, women. It’s not one size fits all.”

This change in attitudes toward HT can be attributed to findings of the Women’s Health Initiative (WHI), a long-term study focused on the prevention of heart disease, cancer, and osteoporosis in postmenopausal women. In 2002, the WHI abruptly stopped its clinical trial focused on HT, announcing that estrogen plus progestin therapy increased risks for breast cancer, heart disease, stroke, and blood clots. This fueled a significant halt in HT prescriptions across the country. However, the average age of women in the trial was 63, or more than a decade past the onset of menopause.

Manson, a lead WHI investigator since its inception in 1993, pushed for further studies in the WHI to examine results of HT by age, years since start of menopause, and risk factors. During the last 10 years, she and other researchers have delved deeply and widely shared their findings that hormone therapy is helpful and appropriate for many women—leading well-known medical societies to recommend its use.

“We can now better target therapy for women more likely to benefit, including those within the first 10 years of menopause, usually below age 60,” Manson says. “As long as they do not have certain risk factors or contraindications, women suffering from menopausal symptoms—hot flashes, night sweats, disrupted sleep, and other impairments in quality of life—should not be denied HT.”

As the nation’s largest preventive health study of women, the WHI enrolled more than 161,000 postmenopausal women in clinical trials and an observational study that examined many aspects of health, including the impact of HT, diet, and calcium/vitamin D supplementation on chronic disease development and bone fractures. Since the main study concluded, thousands more women have participated in extension studies that continue today.