Put HRT risks into perspective

To help women and clinicians put the Women’s Health Initiative (WHI) trial information into perspective, the Washington, DC-based American College of Obstetricians and Gynecologists (ACOG) offers the following explanation:

The WHI population study group included 16,608 healthy women ages 50-79. The data indicate that if 10,000 women take the studied hormone replacement therapy (HRT) regimen for one year, as compared to 10,000 women not taking the hormone combination:

  • eight more will develop invasive breast cancer;
  • seven more will have a heart attack or other coronary event;
  • eight more will have a stroke;
  • eight more will have blood clots in the lungs.

However, among women receiving combination hormone therapy, as compared to the placebo group,

  • six fewer will have colorectal cancers;
  • five fewer will have hip fractures.

The increased breast cancer risk did not appear in the first four years of use. Risks for blood clots were greatest during the first two years of hormone use. The reduced risk of colorectal cancer emerged after three years of hormone use.

"At present, each physician or health care provider should read the WHI paper and in consultation with their patients help them assess their risk benefit ratio and the reasons they started on HRT," advises David Archer, MD, professor of obstetrics and gynecology and director of the Clinical Research Center at the Eastern Virginia Medical School in Norfolk. "Despite the publicity, many women feel comfortable with using HRT and are willing to accept the small increased risk based on the findings of an excess of eight and seven cases of nonfatal myocardial infarction and breast cancer per 10,000 women using HRT per year."

List of resources that you can use

Clinicians who wish to review the findings of the Women’s Health Initiative (WHI) and the implications for hormone replacement therapy (HRT) can consult the following on-line resources:

• The Washington, DC-based Association of Reproductive Health Professionals (ARHP) has posted a web page for the specific purpose of giving providers and the general public information about HRT. Access the information at the association’s web site, www.arhp.org; click on "ARHP Launches New HRT Resource Center for Health Care Providers and the Public."

• The Cleveland-based North American Meno-pause Society offers updates on scientific literature, including information on the WHI trial. Visit the organization’s web site, www.menopause.org; click on "Scientific News."

• The WHI has provided a free fact sheet, available as an Adobe Acrobat PDF file, at its web site, www.nhlbi.nih.gov/whi. Click on "Details of the Early Stopping of Estrogen plus Progestin Trial," then "New Facts About: Estrogen/Progestin Hormone Therapy."

Readers received WHI news in e-mail alert

Contraceptive Technology Update alerted readers of the Women’s Health Initiative (WHI) trial news in a July 10, 2002, e-mail bulletin and posted information on the web site www.contraceptiveupdate.com. If you would like to receive future e-mail bulletins, please contact customer service at (800) 688-2421 or customerservice@ahcpub.com.