Comment: Health Outcomes of the WHI participants

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David Brownstein, M.D.

A recent article in JAMA (4.6.11-Vol. 303, N.13, p. 1305) reported on the health outcomes of women after they stopped taking conjugated equine estrogens (CEE).  This study was a continuation of the Women’s Health Initiative (WHI) project.  This arm of the WHI studied the use of CEE (Premarin) in postmenopausal women with a prior hysterectomy.  The original WHI study was stopped after 7.1 years, due to an increase risk of stroke.  At this time, subjects were told to stop taking CEE. 

This study looked at the health outcomes of the WHI participants 10.7 years after the cessation of the study.  In this follow-up report, researchers found that post-menopausal women with prior hysterectomy followed for 10.7 years after cessation of CEE were not associated with an increased or decreased risk of heart disease, DVT, stroke, hip fracture, colorectal cancer or total mortality.  The decreased risk of breast cancer that was originally reported, persisted.

Although the headlines in the newspapers tried to reassure women that CEE was safe, we feel the media missed the most important part of this study.  The most important part of the WHI was to show the toxicity of synthetic progesterone - progestins (i.e., Provera). 

The original arm of the WHI study which used Provera found a significantly increased risk of heart disease, stroke, breast cancer, Alzheimer’s and pulmonary embolism.  Other studies have shown problems with Provera.  In fact, Provera has been proven to be a dangerous drug and should be pulled from the market.  

Although the present JAMA report is reassuring on the long-term adverse effects from using Premarin, there is no reason to use a synthetic  hormone when a bioidentical, natural hormone is available.  Bioidentical estrogens and progesterone are extremely safe and effective.  They have not been shown to cause the adverse effects of Premarin and Provera. 

I believe that if a hormone is to be used, for any condition, it should be a bioidentical, natural hormone.  More information on how to prescribe and use these hormones can be found on the BHI website and in the teaching modules.

Related articles as reported by the media:

Los Angeles Times: Estrogen-only therapy less risky than first thought.

Los Angeles Times: Advice on hormone replacement therapy continues to evolve.


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