10459
0
Posted on Mar 05, 2005, 5 a.m.
By Bill Freeman
Few bubbles burst with such apparent finality as long-term hormone replacement therapy (HRT) did in the summer of 2002. After many years of study and analysis, researchers determined that HRT, at the very least, increased a post-menopausal woman's risk for a variety of ailments, including heart disease.
Now, there are some second thoughts.
True, the conclusions of the Women's Health Initiative (WHI) in mid-2002 were ominous -- that HRT had some stealthy flaws. The huge WHI, a government-financed study, showed that women taking estrogen and progestin in a single pill had an increased risk of heart disease, breast cancer, stroke and blood clots. Beyond that, the combination HRT did not bestow an improvement in overall quality of life, as promised.
Disillusioned and frightened, women by the millions halted HRT abruptly, side effects of menopause taking a back seat to concerns about survival.
Yet, in the calm after the storm, critics have been chipping away at some of the initial WHI results, pointing out that they may be less threatening than they first appeared.
Indeed, a Yale study in the respected journal Fertility and Sterility found the WHI conclusions fundamentally flawed. The criticism focused on the age of the participants, and not for the first time. The age range of the women was from 50 to 79, with the average age being 63.
Many of the women in the study, say the critics, may well have been in the early stages of heart disease when the trial started. As a result, the trial did not have enough statistical power to test the hormones for primary prevention, they say. The study needed additional younger women.
Dr. Wulf H. Utian, executive director of the North American Menopause Society, is a major critic of the WHI. "Because they (WHI) had to have enough heart attacks to get statistical significance, they had to go with the group that had the highest prevalence of heart attacks -- and that was older women," he said.
