Menopause in crisis post-Women's Health Initiative? A view based on personal clinical experience

Abstract

Menopausal women should not consider that hormonal treatment is an obligatory long-term commitment. Estrogen-based treatments are extremely effective for vasomotor symptom relief and for vaginal atrophy. HRT also is one of several effective methods for the primary prevention of osteoporosis. If trials were done early after the menopause when the endothelium is likely still to be intact, estrogen-based treatment might be shown to prevent coronary heart disease. However, greater efficacy is to be expected from smoking cessation, proper nutrition, exercise, moderate alcohol consumption, statins, beta-blockers and angiotensin-converting enzyme inhibitors. The treatment options for a menopausal woman should include non-drug-related strategies, non-hormonal pharmaceutical therapies as well as hormonal treatments. The first objective of this contribution is to call to the attention of practising physicians the fact that the Women's Health Initiative (WHI) and Heart and Estrogen/Progestin Replacement Study (HERS) studies involved women much older than the early postmenopausal age groups for whom HRT is prescribed because of symptoms. The second objective is to emphasize that the attending physicians must not only treat the symptomatic women but also prevent the occurrence of diseases more prevalent after 60 years of age. Hormones can safely be used for the former, when not contraindicated, whereas for the latter non-pharmacological interventions and non-hormonal medications are preferable.

Hormone replacement therapy: pathobiological aspects of hormone-sensitive cancers in women relevant to epidemiological studies on HRT: a mini-review

“…Recent epidemiological studies with cohort and trial designs on HRT have reported unexpected results. These include previously unanticipated negative effects on cardiovascular disease , quality of life (Hays et al, 2003), cognition (LeBlanc et al, 2001;Rapp et al, 2003;Shumaker et al, 2003), and also on cancers (Chlebowski et al, 2003;Million Women Study Collaborators, 2003) and bone fractures (Rodriguez et al, 2001;Torgerson and Bell-Syer, 2001;Wells et al, 2002; Writing Group for the Women's Health Initiative Investigators, 2002), which in their sum have created considerable discussion concerning methods, content and possible conclusions, and some rethinking concerning the general prescribing habits of HRT to menopausal women (Windler, 2002;Bailar, 2003;Beckmann et al, 2003;Braendle and Kuhl, 2003;Ena and Rozenberg, 2003;Gann and Morrow, 2003;Garbe et al, 2003;Goodman et al, 2003;Grady, 2003;Grodstein et al, 2003;Herrington and Howard, 2003;Luukkainen, 2003;Machens and Schmidt-Gollwitzer, 2003;Neves-e-Castro, 2003;Pedersen and Ottesen, 2003;Shapiro, 2003;Solomon and Dluhy, 2003).…”

When a dream comes through…

“…It took 4 years since my own interpretation of the WHI [1] until the WHI was submitted to several re-analyses [4] that confirmed what I had already concluded: women in the early menopause being treated for the relief of their vasomotor symptoms were protected from CVD [5].…”

“…Therefore I decided to publish my own conclusions [1] which clearly indicated that women under 60 years of age, with vasomotor symptoms, were not at risk of cardiovascular diseases (CVD) while being treated with estrogens plus progestins. The National Institutes of Health (NIH)/WHI investigators had concluded otherwise, saying that 'the findings applied to all women, regardless of age or health status' [2].…”

“…Preventing a woman from the benefits of sound postmenopausal hormone therapy because of the fear of rare side-effects does not seem to be satisfactory medicine [1].…”

The Portuguese Version of the Perceived Control over Hot Flushes Index: Evaluation of its Psychometric Properties

“…For that reason, certain women who manifest vasomotor symptoms might have the necessity of using other strategies to manage them (Reynolds, 2000). Specific behavioural changes, which involve smoking cessation, moderated alcohol intake, a balanced nutrition and physical exercise, have been emphasized as important modifications that will enable a better climacteric period (International Menopause Society Executive Committee, 2005;Neves-e-Castro, 2003). In addition, a literature review has highlighted that psychological interventions might result in a decrease, to a certain degree, of hot flushes' frequency or intensity (Pimenta, Leal, & Branco, 2007).…”