The Insights from the 918

No gynecologist practicing medicine in the year 2000 and on will ever forget the impact of the Women's Health Initiative (WHI). The dramatic swings in Hormone Replacement Therapy popularity that occurred in the 1980s to now has been a Gyno Glitch for many a woman and her gyno! Facts, figures, and more facts and figurs pour at us from this study. In fact if a gyno studied nothing else, she'd be fairly busy studying the WHI facts to sort for her compadres.And no wonder the WHI mission is: The Women's Health Initiative (WHI) was a major 15-year research program to address the most common causes of death, disability and poor quality of life in postmenopausal women -- cardiovascular disease, cancer, and osteoporosis. A tall order to be sure. One of the latest interesting findings has been the subgroup analysis. So if you think the over 65,000 women are not all "like you" the WHI has gone to the trouble of picking out groups of women who may indeed be more like each other and thus analyze their health and hormone effects so that these subgroups could decide how much risk and benefits there are to the use of hormone therapy. They have specifically targeted a group of women from age 50 to 59 to look at. There were 918 of these women studied and they make very interesting reading for those of us who follow the study closely! In fact for women who go on the hormone therapy as they transition through menopause there was (is still thought to be) significant protection against heart disease by the estrogen they took. But as pointed out in the December issue of Menopause in the editorial by Dr Speroff the window of opportunity for this estrogen protection is small and closes in about 2 years! So those well into menopause cannot catch their hearts up by estrogen alone at that point. It's somewhat true of you have had your ovaries out at a pre-menopausal age and didn't treat with estrogen. You, according to the amount of calcium seen in the arteries of these 918 women, would be at more risk for cardiovascular disease than if you did take estrogen right after your ovaries came out. And though WHI data says that first 2 years is critical, the back end number certainly has not been established. Once you get on estrogen, do we now keep women on it again, or is it better for the heart to stop in just a few years? This study, as I always write, was a tremendously important and accurate study. But we have to treat you as an individual gyno patient and we need to know your personal facts and figures and just use the study as one of the flashlights to lead us down the path together!


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