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Recent Hormone Replacement Therapy (HRT) Research

The Study

The Women's Health Initiative (WHI) was the largest randomized-controlled clinical trial of hormone treatment performed under the auspices of the National Institutes of Health (NIH).

This trial was halted in 2002 after five years of study because it was concluded that the health risks outweighed the health benefits for women taking estrogen and progestin.

The reported risks included:

  • increased risk of breast cancer, stroke, coronary heart disease, and blood clots
  • greater risk of heart attack during the first year of treatment

Reported benefits included:

  • fewer bone fractures
  • lower rates of colorectal cancer

For women taking estrogen alone after hysterectomy it was also felt that the risks outweighed the benefits.

The reported risks included:

  • increased risk for stroke

Reported benefits included:

  • fewer bone fractures

The WHI is considered a quality study because women were randomized to take either hormones or a placebo. Their medical conditions were then monitored for the development of disease. Other studies, known as observational studies, are not considered as accurate because they simply observe women who choose to take HRT and compare them with women who choose not to take HRT. One reason this type of study is not considered as accurate is the "healthy-user effect" wherein women who choose to take HRT may be healthier than women who choose not to take hormones.

The HRT Controversy

Some scientists speculate that the WHI studied women who were too far beyond the onset of menopause. Rather than limiting the study to women in their 50's who were just entering menopause (perimenopause), over 65% of the women participating in the WHI were between 60 and 79 years old at the beginning of the study. Starting hormones 10 or more years after menopause may be detrimental because the blood vessels around the heart may already have disease and it is too late for hormones to act in a preventive fashion against heart disease.

It is known that replacement hormones are very effective in treating menopause symptoms such as hot flashes, night sweats, and vaginal dryness. Some doctors and researchers now believe that women who suffer from hot flashes and other severe symptoms of menopause may benefit from a low-dose, short-term regime of hormone replacement therapy.

How TalkToYourDoc Can Help You Reach a Decision Regarding HRT

There is conflicting information and differing opinions regarding the use of HRT, so it is important that each individual discuss options with her health care provider to determine what is best for her. TalkToYourDoc (TTYD) can help with that discussion. While TTYD cannot provide a final answer, it will optimize the interaction between a woman and her doctor and help reach a decision that is best for the individual.

The TalkToYourDoc questionnaire, accessible through the Internet, has been rigorously tested by a group of menopausal aged women who had appointments with their family health care provider or obstetrician/gynecologist. After the women completed the questionnaire at home, a customized printout was produced to take to the doctor for discussion. The women found the printout helped them ask important questions about HRT and share with their doctor appropriate health and medical information pertinent to starting or stopping HRT. The decision process was improved compared to women who did not have the printout. In the visits where women brought the printout for discussion, women came better prepared with appropriate questions. Health care providers felt the communication with their patients was much better, and were more satisfied with the visit compared to visits with women who did not have the printout.

Using the TTYD web-based questionnaire will generate a printout to take to your next doctor visit. The printout will assist with the discussion about your menopause symptoms, your personal and family history of medical conditions, risk factors pertinent to HRT, and relief from menopause symptoms. TTYD will help you and your health care provider decide what is right for you.

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