New Delhi: A pivotal study from the US has revealed findings with significant implications for the treatment of postmenopausal women. The research indicates that while hormone replacement therapy (HRT) may not lower the risk of cardiovascular diseases, it proves beneficial in managing menopausal symptoms, such as hot flashes and night sweats.
The results from the Women’s Health Initiative (WHI) — the largest women’s health study in the US supported by the country’s National Heart, Lung, and Blood Institute (NHLBI) — were published in the medical journal JAMA Network Wednesday.
According to the report, 1.1 billion women worldwide are postmenopausal and the average age of menopause — marked by 12 months since the last menstruation — is considered between 45 and 54 years for a majority of the women.
HRT is a medication that contains female hormones, mainly estrogen, offered to menopausal women as their bodies stop making these hormones naturally, following the cessation of menstruation.
While HRT is commonly prescribed for menopausal symptoms like hot flashes and vaginal discomfort, it is sometimes recommended to safeguard overall health and mitigate the risk of chronic diseases in menopausal women.
Hot flashes are characterised by a sudden and intense sensation of heat in the upper body, often most pronounced in the face, neck, and chest. Night sweats involve recurrent bouts of excessive perspiration that occur during sleep. Both are common symptoms encountered by numerous women during and after menopause.
The latest study, conducted by researchers from Harvard and Stanford Universities, among others, followed over 68,000 women who participated in clinical trials from 1993 to 1998 for up to two decades.
Upon examining the long-term data, the researchers determined that estrogen alone or combined with progestin (human-made progesterone) — two types of hormone replacement therapies — had varying outcomes with chronic conditions. The evidence does not endorse these therapies for reducing chronic disease risks, including heart disease, stroke, cancer, and dementia.
“For postmenopausal women, the WHI randomised clinical trials do not support menopausal hormone therapy to prevent cardiovascular disease or other chronic diseases. Menopausal hormone therapy is appropriate to treat bothersome vasomotor symptoms (hot flashes, night sweats) among women in early menopause, without contraindications (who don’t have other comorbidity or take other medicine which makes them unfit to receive this therapy), who are interested in taking hormone therapy,” researchers noted.
However, they also reinforced the importance of women making shared decisions with physicians about the benefits or risks of taking hormone therapy during menopause.
For instance, women under 60 with a low-to-average risk of cardiovascular disease and breast cancer might find HRT more beneficial than risky for managing moderate-to-severe menopausal symptoms like intense hot flashes or night sweats, the scientists highlighted.
The study also dispelled misconceptions about supplements for menopausal women. It found no link between a combined calcium and vitamin D supplement and a decreased risk of hip fractures in postmenopausal women with an average osteoporosis risk. However, supplements may be necessary to meet the daily recommended nutrient intake for some women, the authors noted.
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Focus on individualised treatment
The study has also shown that a low-fat dietary pattern with at least five daily servings of fruits and vegetables and increased grains did not reduce the risk of breast or colorectal cancer. However, upon subsequent analyses during the follow-up period, researchers found that this type of eating pattern was associated with a reduced risk of death from breast cancer.
“Findings from the clinical trials and study observations can vary based on multiple factors, such as age and underlying cardiovascular disease risks, so women aged 50 and older should work with their clinicians to make individualised and shared medical decisions,” the researchers noted.
Dr Uma Vaidyanathan, senior consultant obstetrician and gynecologist with Fortis Hospital, remarked that the results from the trial underscore the importance of considering individualised treatment approaches for women experiencing bothersome menopausal symptoms.
“The findings emphasise the need for personalised approaches for managing menopausal symptoms and preventing chronic diseases in postmenopausal women. Hormone therapy may offer relief from menopausal symptoms, particularly when initiated early, and in women without contraindications,” she said.
Vaidyanathan highlighted that calcium and vitamin D supplementation should be considered for those with inadequate dietary intake, noting that a nutritious diet could help lower the risk of specific cancer-related outcomes.
“However, further research is needed to better understand the long-term effects and optimal strategies for managing postmenopausal health,” she added.
According to Dr Sapna Lulla, lead consultant obstetrics and gynecology, Aster CMI Hospital in Bengaluru, a lot of what we know of hormone replacement therapy is from (the early part of the) WHI trials from the 1990s.
“However the beneficial effect of such therapy on heart disease was not specified, and another study had shown that there is a two-fold range increase in breast cancer with this therapy, depending on the age and body mass index at the time of usage,” he said.
“Therefore, landmark trials like these are important to guide clinicians and patients through evolving evidence,” Lulla said.
(Edited by Richa Mishra)
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