My initial thoughts on reading the health blog in the May 22nd Wall Street Journal was: what an intelligent article! For truly, this article had “intelligently” left out important facts about hormone therapy (HT) and the Women’s Health Initiative. Left out what would have been much appreciated links to the journal articles that were at the heart of its argument and left out any scientific evidence or citations to support its claims. What it did include were opinions and erroneous impressions of the Women’s Health Initiative (WHI) findings. I would not be surprised, but I would be very concerned, if women came away with the false impression after reading the WSJ blog that they could substitute HT for aspirin and statins, and that since being obese and consuming alcohol increased breast cancer risk it was OK to down play the additional risk of breast cancer from hormone therapy.
I hope that at least some of the women who receive a falsely reassuring impression about the safety and effectiveness of HT turn to sources such as NWHN for more information. First, some facts, the WHI was the FIRST and to date ONLY large randomized clinical trial on HT that included more than 10,000 women and looked at risks for heart disease, stroke and cancer. The WSJ blogger says their conclusions are drawn from scientific articles published in the journal Climacteric. Yet the author doesn’t cite any specific articles. So I went looking and found a few articles in the newest edition of the journal that expressed skepticism of data from the WHI, and claimed that a reanalysis of the WHI did not justify a negative approach to HRT1,2. But I am still searching for a large scale randomized clinical trial (RCT) that provides evidence to back up the claims made in the WSJ. Why am I looking so hard for an RCT? Randomized clinical trials are the gold standard of research studies. They minimize the influence of chance, self-selection and the placebo effect; all of which we know are very important co-factors of menopause hormone use. To put it another way, women need large RCTs to answer the crucial question – does HT make women healthy? Or are healthy women more likely to take HT? The belief prior to the WHI was that hormone therapy improved women’s health by preventing heart disease, osteoporosis and cognitive decline and that any risks were small in comparison. But numerous studies conducted worldwide, including the WHI, established the very real risks of breast cancer, stroke and embolism and found that the benefits were much weaker, and in some cases, non-existent. The WSJ blogger admits the increase in the risk of stroke and embolism even when women start HRT early, and then simultaneously attempts to brush it away saying the risks are only for oral and not for transdermal HT. It is dangerous to mix words especially when those words include serious health problems such as stroke, embolism, heart disease and breast cancer. The fact is that transdermal HT has not been studied yet on a large scale for long enough to even come close to assessing these risks.
Second, the ‘window of opportunity’ idea is one of the arguments used by HT proponents to sneak past the risks of HT. Menopause is treated like an on/off switch, which at ‘the age of menopause’ turns something off and a woman’s physiology changes overnight. According to the article “risks from hormone therapy pertained mainly to women who started HT long after menopause”, and “that women who start HRT before age 60 or within 10 years of menopause have a lower risk” (the window of opportunity idea). I’d just like to use common sense here and ask the question: at what age does a woman achieve menopause? The answer: there is no specific age, no specific number. Women can enter menopause any time in their 40s or 50s or even early 60s, with the average age being 51 years. Menopause itself is a transitional period that can last anywhere from two to ten years. Let’s hypothesize that hormone therapy is protective during the ‘window of opportunity’ nearing menopause and not protective after menopause. If a woman initiates hormone therapy during this window how long must she take it before she knows that the window of opportunity is closed? If she should take hormones near menopause but not after, then when does she have real menopause (the new hormonal milieu), the point after which (according to the article) the risks increase?
The risks of developing breast cancer, heart disease and strokes as a result of long-term use of menopause HT are very real. We don’t need to be ‘for’ or ‘against’ a study like the WHI to be sensible about the risks of HT. We need to seek the truth based on strong scientific evidence. The WHI empowered women, by giving them evidence. Until critics of the WHI can point to another randomized controlled large scale long term study to give scientific evidence to support their ‘opinions’, we will continue to look to the findings of the WHI which tell us that women don’t need menopause HT to age healthfully. I hope women will continue to ask for the evidence when they’re told that something is good for them; and I also hope that outlets like the Wall Street Journal will insist that their writers provide the evidence to back up the claims they make. We deserve it!
Maliha Ali is the 2012 Corfman Intern at NWHN, where she is concentrating on updating fact sheets on menopause, heart disease, breast cancer and cognitive decline.
1.Burger HG, Maclennan AH, Huang KE, Castelo-Branco C. Evidence-based assessment of the impact of the WHI on women's health. Climacteric. 2012 Jun;15(3):281-7.
2.Gompel A, Santen RJ. Hormone therapy and breast cancer risk 10 years after the WHI. Climacteric. 2012 Jun;15(3):241-9.