MEDICATIONS: HORMONE THERAPY AFTER THE WHI

Time to Strike a Balance, Says ACOG Expert

May 10, 2004 — Now that the National Institutes of Health (NIH) has released data on the estrogen-only arm of the Women's Health Initiative (WHI) — coming nearly two years after WHI results on combined hormone therapy were announced to the media — the need for a balanced, analytical public discourse on both the pros and cons of hormone therapy has never been greater, said an expert from The American College of Obstetricians and Gynecologists (ACOG).

"Before the first WHI report was released in 2002, there was an overstatement of the benefits of hormone therapy (HT) in the medical community. Since that time, however, public opinion has probably shifted too far in the other direction — overstating the risks of HT without acknowledging its benefits in relieving menopausal symptoms," said Isaac Schiff, M.D., of Massachusetts General Hospital in Boston, speaking at ACOG's Annual Clinical Meeting. "In fact, some media coverage even seemed to question the very existence of menopausal symptoms and whether women needed relief from them," he adds.

"Now we can truly analyze the data in depth and formulate the best recommendations for women," Dr. Schiff said.

"In the group of women studied in the WHI, the common medical assumption that HT could prevent a variety of diseases including heart disease in women as they aged was not confirmed," noted Dr. Schiff, who chairs ACOG's Task Force on Hormone Therapy and heads the advisory board for ACOG's Managing MenopauseTM magazine. However, he added, "HT is still the most effective treatment for relief of hot flashes, and that scenario is not likely to change soon."

He pointed out, "The WHI was never intended to study the effectiveness of HT in preventing menopausal symptoms like hot flashes. The average age of women in the combined hormone therapy trials was 63 years of age — more than a decade past the average age of menopause (age 51), when women are most likely to experience symptoms," said Dr. Schiff.

"The high quality of the WHI studies was not served by the manner in which the results were released, which probably contributed to the public confusion and anxiety over HT," said Stanley Zinberg, M.D., ACOG's vice president for practice activities. "There has been a lot of confusion for patients and their doctors over the last two years, when we've seen 'guidelines by press release.'''

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