Part 1: Hormone Replacement Therapy, Panacea or Poison?

Appointments with Dr. N can be made by calling (248) 644-7200 and speaking to Caroline

Appropriate Hormone Replacement Therapy (HRT) remains a viable and important health care option for postmenopausal women.

The most significant effects of HRT are increased longevity, a better quality img_8227of life and prevention of the accelerated aging associated with hormone deficiency. This remains true despite a media conflagration generated by the publication of the findings of The Women’s Health Initiative (WHI). The study was published in the Journal of the American Medical Association (JAMA) in July 2002. The article seem to question the wisdom of hormone replacement.

The media response was explosive. Although there was no difference in the number of deaths between hormone users and non-users, many postmenopausal women were concerned and stopped taking their hormones. This impression was reinforced as scores of physicians told their menopausal patients -based on the results of the study, which most had not read - to discontinue hormone replacement therapy.

Are these legitimate responses that reflect the findings of the published study It doesn’t seem so. Five key points follow: 


1) It was not clear to most women that the study did not address hormone replacement in general, but was limited to users of Prempro, which is a sub-optimal hormone replacement preparation.  Prempro is a combination of conjugated equine estrogen (CEE) and medroxyprogesterone acetate (MPA) and is taken daily as continuous combined therapy. It is indicated for use in women who have not had a hysterectomy and require protection of the uterine lining with a form of progesterone, in this case MPA.

2) Hormone replacement with Prempro appears to have a less favorable risk/benefit profile than other replacement preparations, particularly those that are non-oral and those in which a progestin component is not used continuously. The summary of WHI trial suggested that the specific combination in Prempro resulted in: 1) a less favorable effect on coronary arteries than other regimens and 2) a small, but significant excess of breast cancer that in the opinion of the head of the WHI study, Dr. Jacque Rossoux was not due to the hormones used in the study and that the cancers found in the study were there before the study began as the trial was not long enough for any new cancers to be discovered.

3) The weight of previous research utilizing other regimens of hormone replacement had suggested a more positive outcome. The commentary in both studies did state that it was “possible” that the unexpected negative findings were due to the combination in Prempro. Surprisingly, unencumbered by the limitations of the data, the researchers included all forms of hormone replacement in their conclusions and recommendations.

4) Physicians are encouraging women to stop using HRT, without a legitimate rationale. This is an irresponsible and potentially life-altering recommendation. Dr.Rossouw stated that it was his impression that few physicians had actually read the studies or had an in-depth knowledge of the details, or conclusions and went on to say that in his opinion appropriate hormone replacement does not cause breast cancer, or coronary artery disease and that he was “comfortable” with this type of hormone use “for as long as it is necessary.”

5) The big losers are menopausal women who have been deterred from using hormone replacement as a valuable health care and quality of life enhancing strategy.

Dr. Trudy L. Bush, who was one of the nation's preeminent researchers and teachers of issues related to women's health - particularly the effects of hormones and replacement therapy on the cardiovascular and reproductive systems - published a hallmark study in the Journal of the American Medical Association in February of 1983. This examined all-cause mortality in estrogen users compared with non-users. During the 5.6 years of the study, the risk of death among non-users was twice as high as users of estrogen if they had no gynecological surgery. It was three times higher if they had a hysterectomy and eight times higher if both ovaries had been removed. Since that time, Dr. Bush and a number of other respected authors, have published numerous articles confirming the association of estrogen use with lower all-cause mortality.

Dr. Jerry Nosanchuk is a practicing physician who has specialized in the care of menopausal women for over 30 years.  His office is located in Bingham Farms, Michigan.  Appointments with Dr. Nosanchuk can be made by calling: (248) 644-7200 and speaking to Caroline Monday through Friday from 10AM to 6PM

IMPORTANT: This website is for educational purposes only.  It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.