For a number of years, reports in some medical literature and popular media regarding hormone replacement therapy have raised more questions than they have answered. Data has been somewhat sensationalized, reporting the most adverse statistics as a rule. This has caused great concern and confusion for women either considering, currently using, or ever having used some type of hormone
replacement therapy.

No physician would continue to prescribe any type of hormone therapy if it were clear that the risk outweighed the benefits. The now famous
"Women's Health Initiative" was a randomized and prospective control study, known to be the best kind, initiated to determine if hormone replacement therapy could prevent cardiac events for women. One group with uteruses intact used continuous combined hormone replacement therapy (Prempro). The other group, with previous hysterectomy, used Premarin alone. There were other endpoints for
the studies, with each study group having its own control (placebo) group for comparison.

The study was to have lasted for 8 years, but the Prempro arm was discontinued in 2002 (after 5 years) because of an increased incidence of breast cancer in the study group versus the control group. Cardiac events were unchanged in each group, with no benefit noted in the Prempro group. The percentage of increased breast cancer was 30%, but the numbers were quite small. Eight more cases per 10,000 women were present in the study group, versus the control group. The estrogen alone (Premarin) arm did continue for some time, it noted no increased risk of breast cancer, but also no decreased risk as far as
cardiac events.

Some studies had suggested an increased risk of breast cancer with long-term use of hormone replacement therapy, but many studies have actually shown increased survival rate and better long-term outcomes in women on hormone replacement therapy at the time of diagnosis of breast cancer. The mechanics of the relationship remain unclear. Both study groups in the Women's Health Initiative actually had decreased incidence of colon cancer, and hip fracture.

Now in the years following the Women's Health Initiative, current recommendations are hormone replacement therapy is still indicated for symptomatic women in the menopause. The benefits definitely outweigh any potential risks, unless the patient is at high risk for thromboembolic disease. However, the appropriate goal is the lowest dose effective for the shortest period of time required for symptom relief-5 years being a reasonable goal. Women undergoing surgical menopause (surgical removal of the ovaries prior to menopause) likely require a longer treatment regimen before tapering and discontinuing.

If the patient plans to stop using estrogen, a gradual tapering regimen tends to be better tolerated prior to total discontinuation. You should certainly talk to your healthcare professional, who should be able to review with you reasons to either continue your current regimen, stop hormone replacement therapy, change your regimen, or taper and discontinue. You, as the patient, should be comfortable with the reasoning behind that decision. Washington Women's Care is happy to provide current information regarding hormone replacement therapy.

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