Did You Know?

Dr. Carolles's Opinion on the WHI Study

In June 2002 the National Heart, Lung, and Blood Institute of the National Institutes of Health announced that it had stopped the trial after 5.2 years because it showed an increased overall health risk in women taking HRT as compared to placebo. This WHI population study group was 16,608 healthy women ages 50 to 79. The study demonstrated no benefit, and possibly an increased risk, regarding coronary heart disease events (non fatal heart attack or heart attack deaths) and stroke in women taking HRT.

The trial found an increased risk of invasive breast cancer as well as small increases in coronary heart disease, stroke, and pulmonary embolism in study participants taking estrogen plus progestin compared to the placebo group. The trial also found reduced rates of hip fracture and colon cancer. The portion of the trial on women using 0.625 mg of conjugated estrogens alone is continuing, as there was no reported increased risk for breast cancer in this study group.

The data indicate that if 10,000 women take HRT for one year, as compared to 10,000 women not taking HRT 8 more will develop invasive breast cancer after four years, 7 more will have a heart attack or other coronary event, 8 more will have blood clots in the lungs, 8 more will have a stroke with the greatest risk the first year of use owever, among women receiving HRT as compared to the placebo group, 6 fewer will have colorectal cancers, with reduced risk emerging after three years of use, 5 fewer will have hip fractures.

What does this mean to you? How do these numbers relate to your personal decision? You need to know that the increased risks of breast cancer applied to an entire population of women, not to individual woman like you, and that statistics were very small -- less than a tenth of 1 percent per year. These results were only found in women taking 0.625 conjugated equine estrogens in combination with a progestin medroxyprogesterone acetate. They were not found in women taking conjugated equine estrogens alone. 

Would they also apply if you were taking a low dose of 0.3 mg? Should you be concerned if you are taking conjugated equine estrogens with a progesterone such as Prometrium? Or if you are one of the women taking an oral estrogen such as estradiol, etc, which are different from conjugated equine estrogens? What about women on the patch and other progestins or progesterone? These questions can only be answered by doing more studies. As I always advocate, every woman is unique. 

A decision about short-term hormone use (less than 5 years) or long-term hormone use (more than five years), should take into account your individual risk for specific conditions that may be harmed or benefited by hormone use.

The decision about use of HRT requires evaluation of the risks and benefits for each individual woman. For women currently using HRT, it is important to assess their reasons for use and to evaluate potential risks, benefits and alternatives.

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