September 2002 · Vol. 14, No. 9HRT:
4 experts chart a new course
To clarify the issues raised by the Women’s Health Initiative, OBG Management asked 4 experts the inevitable: Now what? Here, the physicians discuss the findings and detail how this will affect the way they—and you—treat menopausal women.
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Our expert commentators
Lorraine Fitzpatrick, MD, is professor of endocrinology and medicine and director
of the Women’s Health Fellowship, Mayo Hospital and Mayo Foundation, Rochester, Minn.
Andrew M. Kaunitz, MD, is professor and assistant chair in the department of OBG at the University of Florida Health Science Center in Jacksonville. He also serves as coprincipal investigator at the University of Florida’s Jacksonville site of the Women’s Health Initiative.
Anthony Luciano, MD, is director of the Center for Fertility and Women’s Health, New Britain General Hospital, New Britain, Conn.
John F. Randolph, Jr., MD, is associate professor and director, division of reproductive endocrinology and infertility, department of OBG, University of Michigan Health System, Ann Arbor, Mich.
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KEY POINTS
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Bisphosphonates and calcitonin, in conjunction with calcium and vitamin D, are as effective as HRT in reducing fragility fractures. Raloxifene also reduces fracture risk.
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Clonidine hydrochloride, a centrally acting antihypertensive agent, has been used successfully as a viable alternative to HRT in the management of vasomotor symptoms.
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Women using HRT for vasomotor symptom relief will benefit from periodic assessment—with guidance from their Ob/Gyn—of the pros and cons of continuing the therapy.
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Choosing whether or not to begin hormone replacement therapy (HRT) is among the most important health decisions menopausal women face. For years, though, physicians have had to guide their patients through the uncertain waters of HRT with only the help of sometimes conflicting, often inconclusive data. But now a new report offers hard-and-fast evidence to aid in this decision-making process.
In July, the estrogen-progestin arm of the Women’s Health Initiative (WHI)—a large-scale, randomized, controlled clinical trial involving 16,608 women—was halted after researchers concluded that the therapy’s risks outweighed its benefits. For this portion of the study, the subjects (all aged 50 to 79 and all with an intact uterus) received either placebo or a combination of 0.625 mg conjugated equine estrogens (CEE) and 2.5 mg medroxy-progesterone acetate (MPA) daily.1
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