Risks and benefits of hormone therapy: has medical dogma now been overturned?

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dc.contributor.authorShapiro, S
dc.contributor.authorde Villiers, T J
dc.contributor.authorPines, A
dc.contributor.authorSturdee, D W
dc.contributor.authorBaber, R J
dc.contributor.authorPanay, N
dc.contributor.authorStevenson, J C
dc.contributor.authorMueck, A O
dc.contributor.authorBurger, H G
dc.date.accessioned2021-10-08T06:55:00Z
dc.date.available2021-10-08T06:55:00Z
dc.date.issued2014
dc.description.abstractBACKGROUND In an integrated overview of the benefits and risks of menopausal hormone therapy (HT), the Women's Health Initiative (WHI) investigators have claimed that their 'findings … do not support use of this therapy for chronic disease prevention'. In an accompanying editorial, it was claimed that 'the WHI overturned medical dogma regarding menopausal [HT]'. OBJECTIVES To evaluate those claims. METHODS Epidemiological criteria of causation were applied to the evidence. RESULTS A 'global index' purporting to summarize the overall benefit versus the risk of HT was not valid, and it was biased. For coronary heart disease, an increased risk in users of estrogen plus progestogen (E + P), previously reported by the WHI, was not confirmed. The WHI study did not establish that E+ P increases the risk of breast cancer; the findings suggest that unopposed estrogen therapy (ET) does not increase the risk, and may even reduce it. The findings for stroke and pulmonary embolism were compatible with an increased risk, and among E+ P users there were credible reductions in the risk of colorectal and endometrial cancer. For E+ P and ET users, there were credible reductions in the risk of hip fracture. Under 'worst case' and 'best case' assumptions, the changes in the incidence of the outcomes attributable to HT were minor. CONCLUSIONS Over-interpretation and misrepresentation of the WHI findings have damaged the health and well-being of menopausal women by convincing them and their health professionals that the risks of HT outweigh the benefits.
dc.identifier.apacitationShapiro, S., de Villiers, T. J., Pines, A., Sturdee, D. W., Baber, R. J., Panay, N., ... Burger, H. G. (2014). Risks and benefits of hormone therapy: has medical dogma now been overturned?. <i>Climacteric</i>, 17(3), 215 - 222. http://hdl.handle.net/11427/34394en_ZA
dc.identifier.chicagocitationShapiro, S, T J de Villiers, A Pines, D W Sturdee, R J Baber, N Panay, J C Stevenson, A O Mueck, and H G Burger "Risks and benefits of hormone therapy: has medical dogma now been overturned?." <i>Climacteric</i> 17, 3. (2014): 215 - 222. http://hdl.handle.net/11427/34394en_ZA
dc.identifier.citationShapiro, S., de Villiers, T.J., Pines, A., Sturdee, D.W., Baber, R.J., Panay, N., Stevenson, J.C. & Mueck, A.O. et al. 2014. Risks and benefits of hormone therapy: has medical dogma now been overturned?. <i>Climacteric.</i> 17(3):215 - 222. http://hdl.handle.net/11427/34394en_ZA
dc.identifier.issn1369-7137
dc.identifier.issn1473-0804
dc.identifier.ris TY - Journal Article AU - Shapiro, S AU - de Villiers, T J AU - Pines, A AU - Sturdee, D W AU - Baber, R J AU - Panay, N AU - Stevenson, J C AU - Mueck, A O AU - Burger, H G AB - BACKGROUND In an integrated overview of the benefits and risks of menopausal hormone therapy (HT), the Women's Health Initiative (WHI) investigators have claimed that their 'findings … do not support use of this therapy for chronic disease prevention'. In an accompanying editorial, it was claimed that 'the WHI overturned medical dogma regarding menopausal [HT]'. OBJECTIVES To evaluate those claims. METHODS Epidemiological criteria of causation were applied to the evidence. RESULTS A 'global index' purporting to summarize the overall benefit versus the risk of HT was not valid, and it was biased. For coronary heart disease, an increased risk in users of estrogen plus progestogen (E + P), previously reported by the WHI, was not confirmed. The WHI study did not establish that E+ P increases the risk of breast cancer; the findings suggest that unopposed estrogen therapy (ET) does not increase the risk, and may even reduce it. The findings for stroke and pulmonary embolism were compatible with an increased risk, and among E+ P users there were credible reductions in the risk of colorectal and endometrial cancer. For E+ P and ET users, there were credible reductions in the risk of hip fracture. Under 'worst case' and 'best case' assumptions, the changes in the incidence of the outcomes attributable to HT were minor. CONCLUSIONS Over-interpretation and misrepresentation of the WHI findings have damaged the health and well-being of menopausal women by convincing them and their health professionals that the risks of HT outweigh the benefits. DA - 2014 DB - OpenUCT DP - University of Cape Town IS - 3 J1 - Climacteric LK - https://open.uct.ac.za PY - 2014 SM - 1369-7137 SM - 1473-0804 T1 - Risks and benefits of hormone therapy: has medical dogma now been overturned? TI - Risks and benefits of hormone therapy: has medical dogma now been overturned? UR - http://hdl.handle.net/11427/34394 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34394
dc.identifier.vancouvercitationShapiro S, de Villiers TJ, Pines A, Sturdee DW, Baber RJ, Panay N, et al. Risks and benefits of hormone therapy: has medical dogma now been overturned?. Climacteric. 2014;17(3):215 - 222. http://hdl.handle.net/11427/34394.en_ZA
dc.language.isoeng
dc.publisher.departmentDepartment of Public Health and Family Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.sourceClimacteric
dc.source.journalissue3
dc.source.journalvolume17
dc.source.pagination215 - 222
dc.source.urihttps://dx.doi.org/10.3109/13697137.2014.905529
dc.subject.otherBENEFIT
dc.subject.otherHORMONE THERAPY
dc.subject.otherRISK
dc.subject.otherBias
dc.subject.otherBreast Neoplasms
dc.subject.otherConfounding Factors (Epidemiology)
dc.subject.otherCoronary Disease
dc.subject.otherData Interpretation, Statistical
dc.subject.otherEstrogens
dc.subject.otherFemale
dc.subject.otherHormone Replacement Therapy
dc.subject.otherHumans
dc.subject.otherMenopause
dc.subject.otherProgestins
dc.subject.otherRisk Assessment
dc.subject.otherEstrogens
dc.subject.otherProgestins
dc.titleRisks and benefits of hormone therapy: has medical dogma now been overturned?
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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