Invited Commentary

Commentary on "Menopausal Hormone Treatment in Postmenopausal Women: Risks and Benefits"

Authors: David F. Archer, MD

Abstract

In this issue of the Southern Medical Journal, Dous and colleagues present the course of events before and since the 2002 publication of the results of the Women’s Health Initiative (WHI), a double-blind, randomized placebo-controlled intervention of conjugated estrogen and medroxyprogesterone acetate in postmenopausal women.1,2 Menopausal hormone treament (MHT) using either estrogen alone or estrogen plus a progestin has undergone dramatic shifts in use by consumers and physicians based on the media reports of the WHI outcomes.3,4 The initial report indicated an increased risk of coronary heart disease (CHD), but this was subsequently refuted in a second publication in 2003. By 2007, studies stratifying by age and years since menopause again indicated no increased risk of CHD in younger women.5,6

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Dous GV, Grodman R, Mornan A, et al. Menopausal hormone therapy in postmenopausal women: risks and benefits. South Med J 2014;107:689-695.
 
2. Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002;288:321-333.
 
3. Corbelli JA, Hess R. Hormone therapy prescribing trends in the decade after the Women’s Health Initiative: how patients and providers have found a way to sleep better at night. Menopause 2012;19:600-601.
 
4. Steinkellner AR, Denison SE, Eldridge SL, et al. A decade of postmenopausal hormone therapy prescribing in the United States: long-term effects of the Women’s Health Initiative. Menopause 2012;19:616-621.
 
5. Manson JE, Hsia J, Johnson KC, et al. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med 2003;349:523-534.
 
6. Rossouw JE, Prentice RL, Manson JE, et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA 2007;297:1465-1477.
 
7. Utian WH. Psychosocial and socioeconomic burden of vasomotor symptoms in menopause: a comprehensive review. Health Qual Life Outcomes 2005;3:47.
 
8. Utian WH, Woods NF. Impact of hormone therapy on quality of life after menopause. Menopause 2013;20:1098-1105.
 
9. Greenblatt RB. Estrogen therapy for postmenopausal females. N Engl J Med 1965;272:305-308.
 
10. Rogers J. Estrogens in the menopause and postmenopause. N Engl J Med 1969;280:364-367.
 
11. Barrett-Connor E, Bush TL. Estrogen replacement and coronary heart disease. Cardiovasc Clin 1989;19:159-172.
 
12. Barrett-Connor E, Bush TL. Estrogen and coronary heart disease in women. JAMA 1991;265:1861-1867.
 
13. Bush TL, Barrett-Connor E. Noncontraceptive estrogen use and cardiovascular disease. Epidemiol Rev 1985;7:89-104.
 
14. Bush TL, Fried LP, Barrett-Connor E. Cholesterol, lipoproteins, and coronary heart disease in women. Clin Chem 1988;34(8B):B60-B70.
 
15. Ouyang P, Michos ED, Karas RH. Hormone replacement therapy and the cardiovascular system lessons learned and unanswered questions. J Am Coll Cardiol 2006;47:1741-1753.
 
16. Changing the face of medicine: Dr. Bernadine Healy. http://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_145.html. Accessed September 22, 2014.
 
17. Barrett-Connor E. Postmenopausal estrogen and heart disease. Atherosclerosis 1995;118(Suppl):S7-S10.
 
18. Clarkson TB, Melendez GC, Appt SE. Timing hypothesis for postmenopausal hormone therapy: its origin, current status, and future. Menopause 2013;20:342-353.
 
19. Grodstein F, Clarkson TB, Manson JE. Understanding the divergent data on postmenopausal hormone therapy. N Engl J Med 2003;348:645-650.
 
20. Archer DF. Premature menopause increases cardiovascular risk. Climacteric 2009;12(Suppl 1):26-31.
 
21. Rivera CM, Grossardt BR, Rhodes DJ, et al. Increased cardiovascular mortality after early bilateral oophorectomy. Menopause 2009;16:15-23.
 
22. Rocca WA, Grossardt BR, de Andrade M, et al. Survival patterns after oophorectomy in premenopausal women: a population-based cohort study. Lancet Oncol 2006;7:821-828.
 
23. Parrish HM, Carr CA, Hall DG, et al. Time interval from castration in premenopausal women to development of excessive coronary atherosclerosis Am J Obstet Gynecol 1967;99:155-162.
 
24. Hodis HN, Mack WJ, Lobo RA, et al. Estrogen in the prevention of atherosclerosis. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 2001;135:939-953.
 
25. ELITE: Early Versus Late Intervention Trial With Estradiol. http://clinicaltrials.gov/show/NCT00114517. Accessed September 22, 2014.
 
26. Design of the Women’s Health Initiative clinical trial and observational study. The Women’s Health Initiative Study Group. Control Clin Trials 1998;19:61-109.