EmpowHer: Dr. Speroff, can you explain the World Health Initiative & if HRT is safe?
Dr. Speroff: Let us give you a little chronologic history. Postmenopausal hormone therapy is one of the most studied subjects in all of medicine. For the last 30 years there has been an enormous amount of research. In the 1980s, there was a growing story of multiple benefits of hormone therapy, principally estrogen and that these benefits were widespread throughout the body. They included not only maintenance of the urogenital tract, but also treatment of hot flashes and a growing story of prevention of osteoporosis and coronary heart disease. As a result, estrogen therapy became very popular. At the same time in the 1980s, we added progestational hormones because in the mid 70s we discovered that giving estrogen alone to a woman with the uterus had a risk of causing uncontrolled growth of the lining of the uterus that would lead to cancer. So the sole purpose of the progestational hormone is to protect against that risk and so the National Institutes of Health organized this huge expensive study called the Women’s Health Initiative. It began to be organized in around 1996 and in 2002, in July of 2002, so it is a five-year anniversary this month, the first publication was released from the Women’s Health Initiative and it argued or claimed that hormone therapy did not protect against coronary heart disease, but in fact increased the risk and that there was a small increased risk of breast cancer as well. Over the last five years, we have come to appreciate that there are problems and limitations in the Women’s Health Initiative. The major problem is that the population of women’s study is not the population of women that we usually treat with hormone therapy. In a nutshell, the population in the Women’s Health Initiative was older and there was a growing collection of evidence that if you gave estrogen in standard doses to older women who already had established atherosclerosis heart disease that it in fact it could stimulate clotting within the heart that could lead to heart attacks, in other words a bad effect. Well, it took a long time for that message to come through.