Effects of Estrogen Alone in Postmenopausal Women: Data from the WHI

Effects of Estrogen Alone in Postmenopausal Women: Data from the WHI

The initial report from the Women's Health Initiative (WHI) in 2002 addressed only use of combined estrogen/progestin therapy (Journal Watch Jul 26 2002). In 2004, results finally were published on the effects of estrogen alone (in women who had undergone hysterectomies).

Because an interim analysis showed that conjugated equine estrogen (CEE) alone had no effect on coronary heart disease prevention (the primary outcome) and significantly increased risk for stroke, the NIH terminated the study early. A trend was noted toward increased risk for venous thromboembolism with CEE use. However, CEE use significantly decreased risk for hip fracture, and, contrary to results of earlier studies, showed a trend toward decreased risk for breast cancer, compared with no hormone use. CEE use had no significant effect on an index of overall risks and benefits. More than 53% of women who had been randomized to CEE had stopped taking it by the time the study was terminated (Journal Watch Apr 27 2004).

In another report from the WHI, recipients of CEE alone had a nonsignificant increase in risk for dementia, compared with controls who received no hormones; this increase became statistically significant only when data from the CEE-alone and the combined CEE/progestin arms were combined. Although mild cognitive impairment (MCI) was increased nonsignificantly in the estrogen-only arm, when probable dementia and MCI were grouped together, risk was increased significantly in this group (Journal Watch Jul 16 2004).

Together, these data provide further evidence that estrogen should not be prescribed to prevent chronic diseases in postmenopausal women; however, estrogen alone conferred less risk than did combined estrogen/progestin therapy. Moreover, a role still exists for estrogen in treating symptoms of estrogen deficiency in women without uteri, particularly because the mean age of women in these studies was older than 60, and estrogens might be associated with lower risk in women nearer to the age of menopause. More than anything else, the reports from the WHI emphasize the need to treat postmenopausal women individually and to discuss risks and benefits with any woman for whom estrogen therapy is considered.

— Robert W. Rebar, MD

Published in Journal Watch General Medicine December 31, 2004

Your Remark:

Reader Remarks are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

The editors of Journal Watch may respond to Reader Remarks, but we cannot promise to respond to a particular remark.

Remark subject:*

Your remark:*

Fields marked with an * are required.

Name as you'd like it to appear:
First & middle initial:*

Last:*

Email address (will not
be published):*

Professional specialty:*

Place of work (optional):

Submitting a comment indicates you have read and agreed to the remark guidelines and declare:*

No competing interests

Or, the following competing interests (for example, financial stakes or professional relationships):

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.

CLEAR erases anything you've added in any part of the form. CONTINUE allows you to check your entire post (and edit it if necessary) before submitting.

To ensure that your Reader Remark is not formatted as one long paragraph, precede new paragraphs with either a blank line or an indentation.