Menopausal Hormone Therapy: Clear as Mud (Part 1)

Well, that cleared things up! The latest analysis of the Women's Health Initiative was published in today's JAMA in which the authors concluded that risks & benefits are not so clear cut. Recall that WHI was a randomized double-blind, placebo-controlled trial involving 27,347 post-menopausal participants 50-79yo at time of enrollment. There wertwo different arms to the study, one involving conjugated equine estrogen (CEE) alone vs placebo and the other involving CEE + progestin, medroxyprogesterone acetate (MPA), which many will tell you is nothing like human progesterone. Of course, these same people will also tell you that equine estrogen is for horses, not humans.

And as you'll no doubt recall, when the CEE+MPA study was originally released over a decade ago, there was a loud outcry as the baby was thrown out with the bath water.  However, others pointed out that the danger was not quite so apparent when CEE alone was analyzed two years later.  So here we are 11 years later.  While the authors still don't recommend CEE either alone or in combination w/MPA for prevention of chronic disease, both are now deemed acceptable options for those women suffering from unbearable menopausal symptoms.  

Use of CEE+MPA remains linked to greater adverse outcomes eg heart disease, breast cancer, stroke, thromboembolism, etc while CEE alone actually continues to be linked to lower risk of breast cancer.  And while neither CEE+MPA nor CEE alone made a dent in all-cause mortality, there appears to be a glimmer of hope when CEE alone is linked to lower all-cause mortality when used by younger menopausal women 50-59yo compared to those 70-79yo.

So where does this leave us?  Stick around for Part 2!

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