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Questions and Answers About the WHI Postmenopausal Hormone Therapy Trials

Questions

Questions and Answers About Estrogen-Alone Therapy


Q. Can you summarize the results of the estrogen-plus-progestin and estrogen-alone studies?

A. Summaries of the findings are given below. However, be aware that the findings for the two studies should not be compared directly because of differences in the women's characteristics at the time of their enrollment in the studies. For example, those in the estrogen-alone study had a higher risk of cardiovascular disease than those in the estrogen-plus-progestin study. Women in the estrogen-alone study were more likely to have such heart disease risk factors as high blood pressure, high blood cholesterol, diabetes, and obesity.

Compared with the placebo, estrogen plus progestin resulted in:

  • Increased risk of heart attack
  • Increased risk of stroke
  • Increased risk of blood clots
  • Increased risk of breast cancer
  • Reduced risk of colorectal cancer
  • Fewer fractures
  • No protection against mild cognitive impairment and increased risk of dementia (study included only women 65 and older)

Compared with the placebo, estrogen alone resulted in:

  • No difference in risk for heart attack
  • Increased risk of stroke
  • Increased risk of blood clots
  • Uncertain effect for breast cancer
  • No difference in risk for colorectal cancer
  • Reduced risk of fracture

    (Findings about memory and cognitive function are not yet available.)

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Q. What advice can you give to women about taking estrogen-alone and estrogen-plus-progestin therapy?

A. We recommend that women follow the FDA advice on hormone (estrogen-alone or estrogen-plus-progestin) therapy. It states that hormone therapy should not be taken to prevent heart disease. These products are approved therapies for relief from moderate to severe hot flashes and symptoms of vulvar and vaginal atrophy. Although hormone therapy is effective for the prevention of postmenopausal osteoporosis, it should only be considered for women at significant risk of osteoporosis who cannot take non-estrogen medications. The FDA recommends that hormone therapy be used at the lowest doses for the shortest duration needed to achieve treatment goals. Postmenopausal women who use or are considering using hormone therapy should discuss the possible benefits and risks to them with their physicians.

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Q. Are there alternatives for postmenopausal hormone therapy?

A. Alternatives exist for treating heart disease, osteoporosis, and the symptoms of menopause. Here's a quick rundown:

  • With increasing age, a woman's risk for heart disease begins to rise. Risk factors for heart disease include smoking, high blood pressure, high blood cholesterol, physical inactivity, overweight/obesity, and diabetes. It's important to follow a heart-healthy lifestyle--this means not smoking, eating a variety of foods low in saturated fat and cholesterol and moderate in total fat, limiting salt and alcohol intake, maintaining a healthy weight, and being physically active. Sometimes, drugs also are needed to control high blood pressure, high blood cholesterol, or diabetes. For those who already have heart disease, the same lifestyle measures can help keep the condition from worsening. In addition, drugs also may be needed to treat heart disease.

  • The risk of osteoporosis increases as women get older. To help prevent osteoporosis, one key step is to follow an eating plan that's rich in calcium and vitamin D. Further, moderate exposure to sunlight helps the body make vitamin D. Another key step is to engage in regular weight-bearing exercises. It's also important not to smoke and to limit alcohol--smoking causes the body to make less estrogen, which protects bones, and too many alcoholic beverages can increase the risk for falls. Osteoporosis is treated by stopping bone loss through lifestyle changes and medication. The drugs used include bisphosphonates, such as alendronate (Fosamax) or risedronate (Actonel), and selective estrogen receptor modulators such as raloxifene (Evista).

  • Alternatives to hormone therapy exist for treating menopausal symptoms. For hot flashes, these include botanical products that contain or act like estrogens. Examples of botanicals are soy and herbs, such as black cohosh. However, limited research has yielded conflicting results on the safety and effectiveness of botanical products. Some antidepressants also are used for relief of hot flashes. They have not been approved for this use, but clinical trials have shown them to be a moderately effective treatment. Lifestyle changes can offer some relief from hot flashes and other menopausal symptoms, especially those that are mildly to moderately bad. For instance, dress to avoid being too warm; reduce stress; avoid spicy foods, alcohol, and caffeine; get enough sleep; and be physically active.

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Q. How can women learn more about WHI and hormone therapy?

A. There are various sources of information, including online materials. Women can check out the following resources:

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April 2004

 

 
 
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