University of Virginia Health System

Hormone Replacement Study Findings Not Well Known

Most women are unaware of the results of a large-scale study that found significant cancer and heart risks associated with long-term hormone replacement therapy (HRT), says a report in the journal Menopause.

But just two years later fewer than one third of women surveyed by Stanford University researchers said they knew about the findings.

"I was quite surprised by that," says study author Dr. Randall Stafford. "Other research had indicated that up to half [of women] had heard about it."

One Third Know About the WHI

When asked if they had talked about hormone therapy with their physicians, the researchers found that 36 percent of women aware of the WHI findings had talked about it with their physicians, compared with 15 percent of women who didn't know about the study results.

"We need to do a better job of disseminating information," says Stafford, referring to the healthcare system.

But another expert familiar with the study viewed the results a bit differently.

Some of the women may not have been thinking about menopause, notes Dr. William Parker of Santa Monica-UCLA Medical Center, since the survey included women as young as 40, for whom menopause is typically five to 10 years away.

"The unanswered question is, 'How many women who need to know the information now do not have it?' " says Parker.

JoAnn V. Pinkerton, M.D., the Division Director for Midlife Health at the University of Virginia Health System, says most women who visit UVA's Midlife Health Center seek out information about hormone therapy only when it's time to make a decision about using it.

"We briefly discuss the issue whenever patients have questions and information is always available," she says. "But I have learned that most women don't want an in-depth discussion of individualized risks and benefits until they are having significant enough symptoms to consider taking hormone therapy."

Pinkerton notes that educating women about menopause involves much more than hormone therapy. Women entering menopause, she says, contend with a range of medical, psychological, social and emotional issues that may include mood disturbances, loss of libido and the risk of osteoporosis and heart disease. But patients interested in learning more about hormone therapy can receive a great deal of information at the Midlife Health Center, Pinkerton says.

"We provide a Menopause Guidebook from the North American Menopause Society as well as information about the large hormone therapy studies, including the Women's Health Initiative (including recent reanalysis confirming that hormone therapy is safe for many menopausal women if they are under 60 or within 10 years of menopause) and the Million Women Study," she says. "We also discuss the lack of scientific safety and efficacy testing with bioidentical hormones and what we know and don't know about alternatives to estrogen for hot flash relief."

Younger Women Will Need Info Eventually

If a woman is not at the point where she has to make a decision about hormone therapy, Parker says says, it would not jeopardize her care if she was unaware of the study and its findings and did not have a conversation with her physician.

In his own practice, says Parker, "If a woman is, say, age 48, and comes in, says she is having occasional hot flashes but is still having periods, I tell her, 'Let's have a conversation when you need it, because this information changes so quickly.'"

Unless a woman needs the information immediately, reasons Parker, time during the office visit would probably be better spent on other concerns or preventive health.

The study was funded by the National Heart, Lung, and Blood Institute (NHLBI) and GlaxoSmithKline Consumer Healthcare. The pharmaceutical company was interested in the data due to its black cohosh product for menopausal symptom relief, says Dr. Stafford.

To learn more about menopause, hormone replacement therapy or other women's health topics, visit www.uvahealth.com.

Always consult your physician for more information.