Walking Back the Decision to Curtail Hormone Replacement Therapy

After waiting several years until the furor died down, it appears that the drug companies and those they fund have decided that the time is ripe to walk back the decision to sharply curtail use of hormone replacement therapy. That decision was based on the landmark 2002 Women’s Health Initiative findings that showed an increased risk of heart disease from HRT, in contrast to previous claims that these medications would decrease heart disease.

See if you can read this article without spotting the not-so-hidden hand of Big Pharma lurking in the shadows. If you arrive at the end of the article without finding it, be sure to read the conflict-of-interest disclosure at the end of the piece.

Menopausal hormone therapy doesn’t have to follow “the lowest dose for the shortest time” strategy for all women anymore, the North American Menopause Society said today.

The group endorsed a flexible approach to duration that takes into account the type and timing of therapy and individual patient characteristics in a statement in its journal, Menopause.

For women in their 50s, the absolute risks are low; younger women without a history of breast cancer can use replacement hormones at least until the normal menopause age around 51, and longer if needed for symptom management, according to the guidelines.

“No ‘one size fits all’ approach is acceptable anymore,” JoAnn E. Manson, MD, DrPH, NCMP, of Harvard, and president of the society, said in answer to a query from ABC News and MedPage Today.

Manson’s position is somewhat surprising since she was a principal investigator for the Women’s Health Initiative, the landmark randomized trial that derailed the hormone therapy movement when it reported a link between Premarin (estrogen/progestin) and increased risk of breast cancer and thromboembolic conditions.

As an organization, “NAMS has close ties with industry, which provides grant support for the organization, advertises in its journal, pays annual dues, etc.,” noted Diana Zuckerman, PhD, president of the D.C.-based National Research Center for Women & Families Cancer Prevention and Treatment Fund.

The new guidelines loosen up on timing, agreed Michelle P. Warren, MD, NCMP, of Columbia Presbyterian Medical Center in New York City, who was also involved with the guidelines.

Women who need hormone therapy can use it for as long as needed, she said in an interview.

That shift should be reassuring for many women, Manson suggested.

After reading the conflict-of-interest disclosures about drug company funding, are you feeling reassured?