COMMENTARY

Hormone Therapy: All We Have to Fear Is Fear Itself

Wholesale Avoidance of HT Can Have Negative Public Health Consequences

Andrew M. Kaunitz, MD

Disclosures

August 21, 2013

Persisting Uncertainty About Hormone Therapy

Clinicians and women have been confused about the findings of the Women's Health Initiative Hormone Therapy clinical trials in 2 important ways:

A failure to distinguish between the safety profiles of ET vs estrogen-progestin therapy; and

A lack of recognition that the risk/benefit profile of ET is more favorable in younger, recently menopausal women than in older women.

This uncertainty has led many clinicians and women to fear and avoid hormone therapy. I see the results of this unwarranted fear in my practice here in Jacksonville, with highly symptomatic, recently menopausal women -- patients who, in fact, are appropriate candidates for hormone therapy -- rejecting the most effective treatment for menopausal symptoms.

ET, like all medications, has risks as well as benefits. For instance, oral estrogen increases the risk for venous thrombosis as well as stroke, whereas long-term use of estrogen/progestin increases breast cancer risk.[4]

However, the current overblown fears result in avoidance of hormone therapy, leading many appropriate candidates to miss out on the symptom relief, prevention of osteoporosis, and treatment of symptomatic genital atrophy that hormone therapy can offer. This provocative report appropriately points out that wholesale avoidance of hormone therapy can also have important negative public health consequences.

Thank you. I am Andrew Kaunitz.

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