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Risks and benefits of hormone therapy: has medical dogma now been overturned?

Shapiro, S and de Villiers, T J and Pines, A and Sturdee, D W and Baber, R J and Panay, N and Stevenson, J C and Mueck, A O and Burger, H G (2014) Risks and benefits of hormone therapy: has medical dogma now been overturned? Climacteric : the journal of the International Menopause Society, 17 (3). pp. 215-22. ISSN 1473-0804.

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Official URL: http://informahealthcare.com/doi/abs/10.3109/13697...

Abstract

BACKGROUND

In an integrated overview of the benefits and risks of menopausal hormone therapy (HT), the Women's Health Initiative (WHI) investigators have claimed that their 'findings … do not support use of this therapy for chronic disease prevention'. In an accompanying editorial, it was claimed that 'the WHI overturned medical dogma regarding menopausal [HT]'.

OBJECTIVES

To evaluate those claims.

METHODS

Epidemiological criteria of causation were applied to the evidence.

RESULTS

A 'global index' purporting to summarize the overall benefit versus the risk of HT was not valid, and it was biased. For coronary heart disease, an increased risk in users of estrogen plus progestogen (E + P), previously reported by the WHI, was not confirmed. The WHI study did not establish that E+ P increases the risk of breast cancer; the findings suggest that unopposed estrogen therapy (ET) does not increase the risk, and may even reduce it. The findings for stroke and pulmonary embolism were compatible with an increased risk, and among E+ P users there were credible reductions in the risk of colorectal and endometrial cancer. For E+ P and ET users, there were credible reductions in the risk of hip fracture. Under 'worst case' and 'best case' assumptions, the changes in the incidence of the outcomes attributable to HT were minor.

CONCLUSIONS

Over-interpretation and misrepresentation of the WHI findings have damaged the health and well-being of menopausal women by convincing them and their health professionals that the risks of HT outweigh the benefits.

Item Type: Article
Subjects: WP Gynaecology. Women’s health
Divisions: Womens and Childrens
Related URLs:
Depositing User: Sophie Rollason
Date Deposited: 30 Jun 2014 10:20
Last Modified: 30 Jun 2014 10:20
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/410

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