Fear over facts

Since the publication of Women’s Health Initiative (WHI) data, a pervasive fear of doing harm has limited the use of all menopausal hormone therapies (MHT) despite newer evidence that is reassuring. Oestrogen therapy (ET), even for women who have a physiological requirement for it, as in those with POI (Premature Ovarian Insufficiency) or surgical (bilateral salpingo-oophorectomy) POI, has markedly dwindled, despite their elevated risk of premature death from cardiovascular disease (CVD).1 2 Now, less than 10% of women with surgical POI use ET, while before 2002, greater than 90% of surgical POI women did.3 This significant shift of not taking ET postsurgical POI had resulted in over 50 000 premature deaths, before age 70, from CVD of women who underwent surgical POI.4 This number represents a sizeable portion of women: spontaneous POI affects 1% of women before age 40, and early menopause (before 45 years) affects 5% of women.5 A recent American Heart Association (AHA) statement supports MHT for reduced CVD risk if started within 10 years of natural menopause or after surgical POI, especially in women younger than 45.6

Almost half of the women in the WHI cohort had early surgical POI with bilateral oophorectomy (BSO) by age 50.2 Using conjugated equine oestrogens plus medroxyprogesterone acetate in the WHI cohort was not found to be protective with a HR of 1.24 (CI 1.00 to 1.57). However, the mean age of enrolled women was 63 years, and they were on average 12 years postmenopausal. However, when analysed by subgroups, HR became less than one, with a HR of 0.89 in women who underwent menopause within 10 years and a HR of 0.95 in women with hot flashes, aged 50–59. But these HRs did …