Money Talks: A Look At The Women’s Health Initiative

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The Truth About The WHI Study

Does your doctor know what’s best for you when it comes to hormone replacement therapy?

Most of us automatically assume that they do, but the truth is many physicians don’t take the time to read through all the reports and recent studies. Physicians are often very busy, and the information they receive is what’s most readily available.

This is why it is important for you to be an informed consumer so you don’t fall into a trap of “the blind leading the blind.”  

This brings us to the Women’s Health Initiative (WHI) study on hormone replacement therapy released in 2002. This highly publicized and well-funded study initially reported that hormone replacement therapy can result in an increased risk of coronary heart disease, breast cancer, stroke and pulmonary embolisms.

As fear set in, doctors and their patients panicked and the number of women on hormone replacement therapy plummeted by the tens of millions, but was this drop justified? Have you or your physician really taken an in-depth look at the WHI studies? Well today we are going to delve a bit deeper and clarify a few facts which have received minimal attention.

WHI Study: Two Parts

The WHI study had two parts referred to as “arms.” Patients in the first arm of the WHI study were prescribed a medication called Prempro. Prempro consists of two medications taken orally; Premerin and Provera. Premerin is a “natural” estrogen (derived from conjugated female horse urine).

However, notice that we have natural in quotes. Premerin is “natural” because it contains natural forms of estrogen, but natural forms to whom? Equilin and Equilenin are two of the main hormones found in Premerin. These hormones are specific to horses, but foreign to humans. Therefore, our bodies must break down these foreign estrogens into ones that are endogenous to humans, such as estrodial.  Provera, the other medication in Prempro, is a synthetic progestin, which means that it is chemically altered in a lab. Provera is used to treat abnormal menstruation or irregular vaginal bleeding (many people are familiar with the injectable form of Provera called Depo-Provera which has been used as a contraceptive).

Over the past several decades Provera has been taken off of the market in several other countries because it is considered to be carcinogenic, yes carcinogenic!

Even here in the United States there has been trepidation about known side effects prior to its use in the WHI study. So it is not surprising that this study resulted in many harmful side effects.

Follow Up Study (Second Part)

How about the follow-up studies? Well WHI released the second “arm” of their hormone replacement study in 2004.  In this study, participants on hormone replacement therapy received Premerin only. Results indicated that participants did not show an increase in breast cancer or many of the negative side effects associated with the first part of the study. Interestingly enough, we have heard little about these results.

Therefore, it does not take a genius to figure out that it is Provera that caused many of the deleterious effects reported in the first study. The unfortunate part is that when this news broke, the findings were generalized to all types of hormone replacement therapy, and the idea that hormone replacement therapy is harmful spread like wildfire.

Since this time there has been minimal coverage regarding the results from the second “arm” of the WHI study.  There have also been limited reports on studies pointing to the positive effects of bioidentical hormone replacement. So before you take your next trip to the doctor’s office and ask about hormone replacement therapy, make sure you do your research and know the facts.

For more information and additional articles, please see the links below, and check back next week as we explore the difference between synthetic, natural and bioidentical hormones.

Article Resources:

http://www.ncbi.nlm.nih.gov/pubmed/12626212

Climacteric. 2002 Dec;5(4):332-40. Combined hormone replacement therapy and risk of breast cancer in a French cohort study of 3175 women.de Lignières B et al.

French Cohort Study.

http://www.womentowomen.com/breasthealth/estrogenbreastcancer.aspx

Causes of Brea6t Cancer- the Estrogen Controversy, Dixie Mills MD

http://content.nejm.org/cgi/content/short/356/25/2591

Estrogen Therapy and Coronary-Artery Calcification. NEJM Volume 356:2591-2602  June 21, 2007  Number 25. JoAnn E. Manson, M.D., et al.

http://www.ncbi.nlm.nih.gov/pubmed/15989413

J Womens Health (Larchmt). 2005 Jun;14(5):410-7. Effects of hormone replacement on progression of coronary calcium as measured by electron beam tomography.Budoff MJ, et al.

http://jama.ama-assn.org/cgi/content/abstract/288/3/321
Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women
Principal Results From the Women’s Health Initiative Randomized Controlled Trial
Writing Group for the Women’s Health Initiative Investigators JAMA. 2002;288:321-333. First Arm.

http://jama.ama-assn.org/cgi/content/full/291/14/1701
Effects of Conjugated Equine Estrogen in Postmenopausal Women With Hysterectomy
The Women’s Health Initiative Randomized Controlled Trial.  JAMA. 2004;291:1701-1712. Second Arm. This is the Second Arm of the Study. Premarin Only.

http://www.ncbi.nlm.nih.gov/pubmed/16841178  Effects of estradiol with micronized progesterone or medroxyprogesterone acetate on risk markers for breast cancer in postmenopausal monkeys.Wood CE et al. Breast Cancer Res Treat. 2007 Jan;101(2):125-34.

http://www.time.com/time/magazine/article/0,9171,1002897,00.html

The Truth About Hormones Monday, Jul. 22, 2002 Time Magazine. By CHRISTINE GORMAN AND ALICE PARK

http://breast-cancer-research.com/content/7/3/131
The protective role of pregnancy in breast cancer. Jose Russo et al.Breast Cancer Research 2005, 7:131-142doi:10.1186/bcr1029

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17257424
Hormone-induced protection of mammary tumorigenesis in genetically engineered mouse models
Lakshmanaswamy Rajkumar et al.Breast Cancer Res. 2007; 9(1): R12.

http://www.annclinlabsci.org/cgi/content/abstract/28/6/360

Progesterone inhibits growth and induces apoptosis in breast cancer cells: inverse effects on Bcl-2 and p53.  B Formby and TS Wiley. Annals of Clinical and Laboratory Science, Vol 28, Issue 6, 360-369