What has happened to menopausal hormone therapy?

We all remember 2002, when the large Women's Health Initiative (WHI) trial data was published.  The study of estrogen plus progesterone was stopped in July of 2002 because of too many cardiovascular events and too many breast cancers.  The risks of using combined conjugated equine estrogens with medroxyprogesterone in postmenopausal women was shown to outweigh the benefits.  With this finding came new guidelines from the FDA and other professional organizations that supported using as little as possible for the shortest period of time to treat menopausal symptoms.


A recent study published in Menopause: The Journal of The North American Menopause Society by Tsai, et al, evaluated the trend in hormone replacement from 2001 (before the report) and 2009.


Data from the IMS health survey of office-based physicians were extracted from a National Disease and Therapeutic Index that provides national cross-validated numbers.




The results are that menopausal hormone replacement therapy (MHT) has declined each year since 2002.  The greatest percentage decline was in the first year.  Declines were greatest for older women, but declined at all 3 ages studied


Declines:          women over 60 years          64%
                      women 50-59 years             60%
                      women under 50 years         59%


The use of combined estrogen and progesterone declined more than the use of estrogen alone.


Use of lower dose products increased about 30%.


What dose this mean?  The authors suggest that the increase in use of lower dose products does "reflect clinical recommendations" but has been "modest".  Furthermore they note that substantial use continues in the older women who are at increased cardiovascular and breast cancer risks.




Certainly there is more to learn about different subpopulation groups and well as dosage, timing and route of administration.


One other limitation of this study is lack of information on patient symptoms.  That is what those of us who write menopausal hormone replacement prescriptions also have to consider.  A second limitation is the lack of information about personal breast cancer risk.  We now have more tools to help us here like BREVAGen and HALO.  A third limitation is the lack of information about use of non-hormonal treatments that have shown less risk.  Not everyone is symptomatic without hormones.




So, it is a decision for the woman and her doctor to make, discussing her personal risk/benefit ratio.






Together, we can prevent 75,000 breast cancer cases each year!