The World Health Initiative’s (WHI) report more than 20 years ago led to some confusing conclusions about menopause and hormonal therapy. Today, armed with a more nuanced view of the data, physicians can have more thoughtful conversations with their patients and help them gain much needed relief.

Hot flashes, mood swings, and lack of energy can be harbingers for women that menopause is near. The depletion of estrogen can also predispose a woman to
osteoporosis, cardiovascular disease, and diabetes. Hormonal replacement therapy (HRT) has been found to be extremely beneficial for women in terms of decreasing their discomfort during menopause. Usual hormonal therapy has been given in the form estrogen and progesterone (for women who have uteruses) or as estrogen alone (for women without a uterus).

Even though millions of women have undertaken HRT, a lot of confusion surrounding HRT remains. Much of this confusion follows the suspension of a study by the World Health Initiative, which was looking at the health outcomes for 160,000 postmenopausal women undergoing HRT. The HRT arm of the study was halted early in 2002 when the director reported that the therapy carried a small but statistically significant increased risk of cardiac events and an increased risk of breast cancer.

While the elevated risks have been widely discussed, several important takeaways are not always noted. In particular, the World Health Initiative study looked at women older than when HRT would typically be considered. Generalizing the results of older, postmenopausal women to women just beginning menopause may not be appropriate. With this in mind, further discussion of HRT and its risks is beneficial for many women. The conversation surrounding HRT is a complex one.

Menopause is a time of change and readjusting. Women may not feel as comfortable in their bodies, and they may even have depression, anxiety, or insomnia. At CalPsychiatry, our physicians can screen for mental health issues associated with menopause and perimenopause and help you devise a plan. Call or book an initial consultation at one of our convenient California locations.


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