Published in ASRM Announcement
The American Society for Reproductive Medicine, with more than 9,100 members the largest nonprofit professional scientific society devoted to the study of reproductive medicine in the United States, thanks the organizers of this meeting for the opportunity to present our opinions about the initial findings of the Women’s Health Initiative.
In three minutes there is little new that we can add to this discussion. Hundreds of thousands of words have been written – and many more spoken here – about the findings of the Women’s Health Initiative. The data emerging from this methodologically sound randomized controlled trial appear incontrovertible. However, as is true for all studies, generalizability may be limited, and this study represents but one of many on the impact of gonadal steroids in women. Moreover, the data are entirely consistent with observations from earlier restrospective analyses and from smaller prospective trials. They indicate that there are real but small risks associated with use of combined menopausal hormone therapy (HT) and that the benefits and risks need to be carefully considered by each individual woman together with her physician. Data from the WHI make it clear that the risks to the population at large, with millions of women treated with combined HT for many years, make this an important public health care issue, but it is also important to remember that the risks to each individual woman are very small indeed. It would appear that over 97.5% of the women in the trial had no serious sequellae during the period of observation.
Some physicians have commented to the press – and to their patients – that the WHI data indicate that combined HT is so dangerous it should not be provided to any women. We strongly disagree with these upsetting and careless opinions.
Estrogen remains the most effective treatment for vasomotor and other symptoms of estrogen deficiency appearing after oophorectomy and at menopause. These symptoms can be incapacitating to some women; moreover, for some women only estrogen provides relief. We must remember that managing vasomotor and genitourinary symptoms is – and should be – the primary reason for providing therapy to women. The intent of estrogen therapy has always been to improve the quality of life. To withhold estrogen may impact significantly on the lives of many women around the time of menopause. There is no question that these data alter usage of estrogen and emphasize the need for even more careful discussion of the risks and benefits of hormone therapy, but the findings of the WHI should not lead to abandoning the use of estrogen in all women. Such a result would be no less irresponsible than providing hormone therapy to all postmenopausal women.
On our part the American Society for Reproductive Medicine urges continued basic and clinical research into the effects of gonadal steroids on diverse body systems. The findings from the WHI should not be viewed as the final word. Only through understanding the actions of estrogens and progestins more completely can we develop safe and effective new approaches to therapy.
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