The Truth about Hormone Replacement Therapy

In July 2002, the NIH Women’s Health Initiative (WHI) made a dramatic public announcement suggesting a link between Hormone Replacement Therapy (HRT) and increases in heart attack, stroke and breast cancer in women.

I still remember seeing the headlines at my work desk. Like perhaps everyone else, I worried for women.

The 2002 Hormone Replacement Therapy Study

What It Really Showed

Once I looked at the actual study, I was shocked and worried in a different way: Shocked to see how far away the study was from the headlines and worried that the headlines would dominant women’s choices.

The study showed limited absolute risks (only about 1% increases in the negative outcomes that the headlines blasted into the world).

Hormone Hysteria

Even with these miniscule finding, the public, physicians and women began to base whole new protocols on this one study!

Menopausal HRT use dropped from approximately 25% of menopausal women in the US on HRT pre-headlines to about 5% several years after.

Sadly, this hormone hysteria got it wrong. These WHI findings so firmly touted in 2002 have recently been withdrawn even by the study investigators themselves.

Many of the side effects noted in the study were actually caused by the wrong dose and type of HRT and the medications were started in women over 60 (the average age was 63)—in women long past menopause.

Even the way the study was designed and analyzed has become suspect, so much so that the Founder of the North American Menopause Society published a call to action in 2012 titled “Billion Dollar NIH Study May Have Harmed Women’s Health,” claiming that the analysis of the WHI study was so “compromised” that an “independent commission of enquiry” was required to review the study conclusions.

Perhaps the saddest thing in all this bad medicine is the actual harm to real women it caused.

Estimates are that the millions of women who stopped HRT after this study have had collectively over “43,000 more bone fractures each year” and likely a greater number of cardiovascular events (the leading cause of death in women). Additionally, “The negative impact on quality of life through recurrences of hot flashes and impaired sleep is immeasurable.”

Even the scientists who did the WHI research have stated that the work was “wrongly” interpreted and led to “needless suffering.”

An entire generation of women, those with the longest projected life expectancy to date, stopped HRT because of ONE study with significant flaws. And to this day women are frightened of HRT, with only 11% thinking it is a good thing to do, even though 73% of physicians feel that their patients would benefit from it.

The Politics of Hormone Replacement Therapy

The headline many people saw in 2002 regarding the WHI was: “Hormone replacement therapy associated with a 38% increase in stroke risk.” But let’s look at these study results a little closer so we can arm ourselves against similar situations in the future. Arming ourselves effectively will mean penetrating the politics of health care research.

In the study itself, the 38% in the headline actually represents the “relative risk” difference in stroke risk. Relative risk compares one outcome to another – such as comparing a 1% rate to a 2% rate being a “100% increase.” It was not the “absolute risk” difference. Absolute risk is the differential you should almost always look for.

In actuality, the absolute risk for stroke in the study increased from 0.24%  (2.4 women per 10,000 treated) in the placebo group to 0.33% (3.3 women per 10,000 treated) in the HRT group. This represents a 0.09% absolute increase.

That’s right: An increase of less than one-tenth of 1% caused this inflammatory headline!

What if this data had been presented to say (as was true and more responsible) that for women with no HRT in the placebo group their annual chance of not having a stroke was99.76%, but for women who were on HRT, their annual chance of not having a stroke went down by a fraction to 99.67%.

Either way, women in both groups had over a 99% chance of not having a stroke! If data had been presented this way, would 89% of US women in 2013 believe that HRT was unsafe?

Do as I Do – Doctor’s Use of Hormone Replacement

Often a good way to make medical decisions is to ask your physician what they are doing or recommending for their family members.

Physician and physician family members around the world use HRT at a much higher rate than does the general population, and these folks stay on the HRT much longer than most patients. HRT use rates in women physicians or male doctors’ spouses aged 50-64 were 66% in Britain; 71% in Scandanavia, and 59% in Italy.

Only 8% of women doctors around the world stopped taking HRT after the WHI in 2002, as compared to up to 80% of lay users.

- Dr. E

Science can help us nurture and enjoy our sexual selves.


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