Hormone Replacement Therapy (HRT)

Two years after the publication of the first of the results from the Women’s Health Initiative (WHI) study a survey was undertaken to ascertain how aware women were of the WHI results or were familiar with the risks and benefits associated with the use of Hormone Replacement Therapy (HRT). The journal Menopause has recently published the results of a survey of almost 800 women aged between 40 and 60 which found that two years later only 29% of women were aware of the WHI results, and fewer than half were familiar with the pros and cons of the therapy.

First WHI results published
In 2002 there was major media coverage of the fact that hormone therapy which was routinely given to menopausal women had been found to increase the risk of breast cancer, heart attacks and strokes. The first results of this major study failed to confirm previous expectations about the benefits of HRT and found that it actually did more harm than good. One of the results was an immediate drop in the number of prescriptions for hormone therapy. Since then other findings have been published which show women using HRT also are at increased risk of developing ovarian and endometrial cancer.

A nationally representative survey was carried out of 781 women aged between 40 and 60 years of age with the main outcome measures being awareness of WHI and knowledge of its findings. The researchers found that only 29% of women were aware of the WHI results and only 40% had a positive knowledge score of the impact of hormone therapy on seven key disease outcomes. Knowledge scores were lower for African American women and among women with less education. Knowledge was greatest for breast cancer and osteo-porosis outcomes and most limited for colorectal cancer and memory loss. The lead author of the study, Alison Rigby of Stanford University said the findings revealed that more education was needed so women could make informed decisions.

“While doctors are presumably much more likely to be aware of the risks of the therapy, this was not enough. It was unclear how much some doctors knew about hormone replacement, and, just as important, how well they educated their patients,” Dr Randall Stafford, the senior researcher said.

“By and large, he said, “patients are very frustrated and disappointed by the sort of communications that they have with their physicians.”
· Alison J Rigby et al. Menopause 14(5):853-858, September/October 2007.



The menopause industry is alive and well and appears to be recovering from the major setback resulting from the publication of the risks associated with the use of HRT (Hormone Replacement Therapy) in 2002.

At the end of September 2006 members of the Australasian Menopause Society gathered in Wellington for their 10th Annual conference, “A cultural change – health beyond the menopause.” The conference began by exploring issues around sexuality and sex after 50 in particular. Other issues on the agenda were breast and other cancers, healthy life from womb to tomb, post-menopausal bone health and life after WHI. What was even more interesting were the unacknowledged agenda items that included discrediting the Women’s Health Initiative study findings, and promoting new hormones/drugs to manage women’s sexuality.

Life after WHI
The Women’s Health Initiative (WHI) study caused immense damage to the menopause industry which had been reaping the benefits of promoting HRT to women as the elixir of youth and the cure to a growing list of menopause symptoms for several decades. The WHI is the largest and most comprehensive study of post-menopausal women’s health ever conducted in the USA. The 15-year project involved 161,808 women aged 50-79 and results from the clinical trials replaced conventional “wisdom” about women’s health with evidence-based research findings, revealing that the risks outweighed the benefits and women had been badly misinformed about HRT.

However it wasn’t long before the pharmaceutical industry – dismayed at the rapid drop in sales of their wonder drugs – and the health professionals who had jumped on the bandwagon and set up meno-pause clinics peddling these drugs to menopausal women, began to fight back. Among other strategies they began casting doubt on the findings of the WHI.

On Friday 22 September 2006 Professor Susan Davies, one of the Australian presenters at the conference went on National Radio to talk about menopause and sex after 50. During the interview the talk inevitably turned to the role of hormones in sexual functioning and the decline in hormonal activity that occurs with age. The male hormone testosterone is now getting a makeover and women are now being fed a line about the need for testosterone and its importance as a hormone essential for sexual functioning. Unfortunately for women – but potentially very fortuitous for the pharmaceutical industry – levels of both testosterone and its precursor or parent hormone DHEA decline from the early 20s. Professor Davies described how testosterone levels in 40 year old women are only 50% of what they are in women in their early 20s, and how DHEA levels also drop steeply with age so that by the time women are in their 70s they have only one third of the levels of DHEA they had in their 20s. She admitted that there have been no large or long-term studies on DHEA so there is no safety data on this hormone. In fact there is no data to even suggest that DHEA improves quality of life. But rest assured they have started looking!

Professor Davies is part of a team undertaking research into this hormone. If the levels of DHEA start declining in women in their early 20s, just think how much money could be made by getting women on DHEA pills before they hit 30! Why, the thought is enough to bring on a hot flush!

Discrediting WHI
It was at this point in the conversation that the discrediting of the results of the WHI study began. Professor Davies stated repeatedly that the results of the WHI study were published precipitously and the authors were now not standing by their published results. She said the WHI papers were not critiqued properly by the reviewers before they went to press because it “was a massive multi-million dollar investment of government money.” Furthermore she claimed “the data has been very misconstrued” and “there is absolutely still no evidence that the use of HRT around the time of menopause increases the risk of heart disease.” In fact “the authors were now coming out at academic meetings across America saying “in retrospect that it’s not quite like that.”

Then came the marketing spiel for the testosterone patch which has yet to be approved for use in either Australia or New Zealand. Her final comment: “Women have the right to therapeutic options.” Yeah, right!

September 2006