Robert Filice, M.D. - Dr. Bob's Newsletter
Hormone Replacement and Cardiac Risk
Everyone remembers the panic that ensued after the WHI study results came out several years ago. Gynecologists and women patients abandoned hormone replacement (HRT) as rapidly as they had originally embraced it because of the risks of cancer and other problems.

One of the study's other conclusions was that replacement hormones did not seem to offer protection against coronary events as had been widely promoted. Further analysis of the data tells another story. In fact, researchers found that there WAS a window of opportunity for women who wished to reduce coronary risk, and that protection, a 30% drop in coronary mortality risk, is available to those who begin hormone replacement near in time to the onset of menopause, or immediately after total hysterectomy.

Most of the women in the WHI study were started on HRT more than 10 years after the menopause, and most of these patients enjoyed no lower risk of coronary disease than those women who had never taken HRT. In other words the hormone therapy was not protective.

Another factor that is worth commenting on is that the WHI study reported findings based on comparative or relative risks, rather than absolute risks. Thus, although the incidence of a side effect may have shown a 2x relative risk for a particular negative effect, the absolute incidence is still within what would be considered "rare". Still, many medical professionals now view the appropriate use of HRT to be limited to the temporary management of the uncomfortable symptoms common to the menopausal transition.

Here's what I think.
The WHI study clearly showed that synthetic pharmaceutical preparations for hormone replacement therapy puts women at greater risk adverse medical consequences compared to those who do not take them. However even with the synthetic hormones, the risk of that happening is not great. On the other hand, identical to natural hormone replacement therapy (NHRT), started soon after or during menopause, offers the hope of gaining many health and anti-aging benefits without the risk of causing other problems.

I have not seen any patient on natural hormones who has run into any serious adverse consequences. This makes sense because we are using nature's own molecules in proper doses and in proper balance. In view of this safety profile (although I will grant you that I can quote no large studies of patients like the WHI study), I believe that women should consider the advantages of earlier rather than later starts to their hormone replacement. If this is done there will be cosmetic (skin and muscle), vitality, libido, and organ and tissue (e.g. heart, muscle, and bone) benefits that will promote health and longevity, and sustain an active and more youthful quality of life.
 

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