Ten Wasted Years
Having been involved for many years in advising, educating and always still learning myself about the menopause, the effects of estrogen deficiency, and treatments , I have seen many changes but none so dramatic as the views on Hormone Replacement Therapy (HRT). In the early days, HRT was seen as the answer to many problems and while it was known that it was not perfect and that all medicines carry some risk, it was strongly believed that for most women, the benefits outweighed the risks. Then, in July 2002, publication of the Women’s Health Initiative (WHI) trial led us to be more concerned about risks and less aware of benefits with a subsequent huge fall in the use of HRT.
Ten years on and a full review of the WHI trial and of other available evidence has been published. The key message is that in fact, when used appropriately especially for women under the age of 60, or within ten years of the menopause, HRT provides far more benefits than risks. It is reassuring that the media did give this news some attention, since women and their healthcare providers need to be aware of this information, so that they can make informed choices about the management of their menopause. It seems that for the last ten years, decisions have been made based on incorrect information.
Many have stated that as a result of the WHI trial and the ensuing publicity, we have had ten wasted years and that women have suffered unnecessarily. This may be the case but we cannot turn back the years and decisions were made in good faith. Lessons have been learnt and perhaps we should realise that major shifts in practice should not be based on one study, no matter how large. Women can once again be reassured that HRT is safe when used correctly and while not all women will need HRT, those that do need not worry unduly about risks but can enjoy the benefits. It is time to move on.