Risks and benefits of hormone therapy: has medical dogma now been overturned?
Climacteric
; 17(3): 215-22, 2014 Jun.
Article
em En
| MEDLINE
| ID: mdl-24654673
ABSTRACT
BACKGROUND:
In an integrated overview of the benefits and risks of menopausal hormone therapy (HT), the Women's Health Initiative (WHI) investigators have claimed that their 'findings do not support use of this therapy for chronic disease prevention'. In an accompanying editorial, it was claimed that 'the WHI overturned medical dogma regarding menopausal [HT]'.OBJECTIVES:
To evaluate those claims.METHODS:
Epidemiological criteria of causation were applied to the evidence.RESULTS:
A 'global index' purporting to summarize the overall benefit versus the risk of HT was not valid, and it was biased. For coronary heart disease, an increased risk in users of estrogen plus progestogen (E + P), previously reported by the WHI, was not confirmed. The WHI study did not establish that E+ P increases the risk of breast cancer; the findings suggest that unopposed estrogen therapy (ET) does not increase the risk, and may even reduce it. The findings for stroke and pulmonary embolism were compatible with an increased risk, and among E+ P users there were credible reductions in the risk of colorectal and endometrial cancer. For E+ P and ET users, there were credible reductions in the risk of hip fracture. Under 'worst case' and 'best case' assumptions, the changes in the incidence of the outcomes attributable to HT were minor.CONCLUSIONS:
Over-interpretation and misrepresentation of the WHI findings have damaged the health and well-being of menopausal women by convincing them and their health professionals that the risks of HT outweigh the benefits.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Progestinas
/
Neoplasias da Mama
/
Interpretação Estatística de Dados
/
Doença das Coronárias
/
Terapia de Reposição Hormonal
/
Estrogênios
Tipo de estudo:
Etiology_studies
/
Risk_factors_studies
Limite:
Female
/
Humans
Idioma:
En
Ano de publicação:
2014
Tipo de documento:
Article