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.
Dr. Speroff: In the meantime, women all over the world stopped taking hormone therapy in response to the negative publicity that came from the initial reports from the Women’s Health Initiative.
EmpowHer: Oh wow, so did the divorce rate go up?
Dr. Speroff: Oh well, I can’t comment on that. The problem was the investigators and the NIH did a disservice, a major disservice to clinicians and patients and that is that they took conclusions that were limited to a specific population and said that these conclusions applied to all postmenopausal women. Now this month five years later we have two publications from the Women’s Health Initiative. Finally, they looked at the youngest women in their study and found in fact that estrogen protected the youngest women in the study from heart attacks, from atherosclerosis, which is exactly what research has been saying for almost 30 years. So the initial adverse publicity said wait, all those studies have been wrong, we are right and we have a new contrary evidence and now five years later we realized that in fact they were not, all those studies were not wrong that the initial WHI was providing evidence on a specific population, not the younger postmenopausal women from age 50 to 65 who usually take hormone therapy and as a result I would predict there will be a rebound, a growing emphasis once again of the multiple benefits of hormone therapy including protection against heart disease.
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After graduating Case Western Reserve University School of Medicine, Dr. Speroff completed his residency at Yale-New Haven Hospital in Ohio. Following fellowship training at the Worcester Foundation for Experimental Biology in Shrewsbury, Massachusetts, he spent a number of progressive years at Yale University School of Medicine, New Haven, Connecticut until he became a member of the OHSU faculty as professor and chairman of the department of obstetrics and gynecology in 1976. In 1983 he returned to his Alma Mater, Case Western Reserve University School of Medicine as professor and chairman of the department of reproductive biology until returning to OHSU in 1989. He is the founder and recently stepped down as director for the Women's Health Research Unit at OHSU. Doctor Speroff has gained prominence in the area of women's health throughout his publications, national and international lectures and extensive work on clinical trials.