UMMS study finds some women may be missing out on benefits of menopausal hormone therapy

Analysis revisits 2002 Women’s Health Initiative recommendations in light of updated guidelines

By Sandra Gray

UMass Medical School Communications

January 09, 2019
  Sybil Crawford, PhD

Sybil Crawford, PhD

The number of women using menopausal hormone therapy plummeted nearly 20 years ago, when the historic Women’s Health Initiative found that such therapy could increase the risk of heart disease and breast cancer. But subsequent research has shown there is less risk for women who are younger and earlier in the menopausal transition than the women initially studied.

A new study concludes that findings from the Women’s Health Initiative estrogen-progestogen trial were widely disseminated, and that younger women with menopausal symptoms, particularly hot flashes, may have avoided hormone therapy as a result, despite a favorable benefit–risk ratio for their age group.

“We looked at who takes hormones pre- and post- the Women’s Health Initiative to determine if the message was disseminated uniformly. There were decreases in use among every subgroup,” said Sybil Crawford, PhD, professor of nursing and lead author of the study, published online in December by the journal Menopause. “I think some clinicians and women overheard the message, however. It’s not that menopausal hormone therapy is uniformly dangerous, but that individual women should more carefully consider their own risk–benefit ratio.”

The analysis of survey data taken at annual medical visits from 1996 to 2013 by 3,018 participants in the Study of Women’s Health Across the Nation showed that initiation of menopausal hormone therapy has dropped by more than two-thirds, and the number of women who stopped using it rose more than 25 percent since 2002. Researchers found decreases of therapy across a range of subgroups and, contrary to current guidelines, there were large declines among younger women and those with more vasomotor symptoms, for whom therapy is often recommended.

In 2017, the North American Menopause Society recommended that women who are younger than 60 and less than 10 years past their final period should weigh individual risks such as pre-existing cardiovascular disease in shared decision making with their health care providers. Importantly, recent Women’s Health Initiative findings indicate no difference in deaths from all causes between women who did and did not use hormone therapy.

“We focused on women in the menopause transition ages 42 to 52 who had a period within the last three months before joining the study, a very different cohort than the original [study],” said Dr. Crawford. “The group we would have expected to initiate or continue hormone therapy was symptomatic women, but they didn’t, which is not consistent with the updated recommendations.”

Underway since 1996, the Study of Women's Health Across the Nation examines the health of women during their middle years by examining the physical, biological, psychological and social changes during this transitional period. The goal of the research is to help scientists, health care providers and women learn how mid-life experiences affect health and quality of life during aging.

Related story on UMassMedNow:
New study, co-authored by Sybil Crawford, finds hot flashes can persist for many years