On the need to clarify and disseminate contemporary knowledge of hormone therapy initiated near menopause.

摘要

The dramatic change in opinion on postmenopausal hormone therapy (HT) following initial reports from the Women's Health Initiative (WHI) came about as the 'baby boom' generation of women created the largest population of newly menopausal women in history. That trial of conjugated equine estrogen (CEE) plus medroxyprogesterone acetate (MPA) focused on outcomes in women starting HT a decade or more after menopause. Yet clinical practice has focused on initiation near menopause. Recent findings in the limited numbers of younger menopausal women in the WHI CEE + MPA trial, and findings in the CEE-only trial, suggest that age at initiating HT strongly influences outcomes, and that benefits greatly exceed risk for most women who start within 10 years of menopause. Findings in other cohorts support this view. Benefits are both short (vasomotor, dyspareunia) and long term (bone health, possible coronary risk reduction). Not all postmenopausal women have indications for HT, but, even if the fraction is one-third, the numbers affected are staggering. Low-dose and non-oral regimens, and other compounds, were introduced in the wake of the WHI. Emerging evidence suggests that these may further reduce risk in some population subgroups. The demonizing of HT may already have caused a burden of chronic disease that could have been mitigated or delayed. It is time for action to re-establish appropriate clinical context based on this emerging evidence, to reverse the inappropriate broad generalization of the WHI findings to younger menopausal women, and to support outcomes studies of current regimens in younger menopausal women.