MHT: then and now

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In the 1990s, menopause hormone therapy (MHT) was regarded as the “elixir of youth” and frequently prescribed by gynaecologists – not only for the relief of menopausal symptoms but also as long-term therapy to protect against heart disease, osteoporosis and ageing in general. “Feminine forever” was a catch phrase in America at the time.

When the findings of the five-year Women’s Health Initiative (WHI) study were published in 2002, concern began to mount that MHT could increase the risk for heart disease, stroke and breast cancer. Many women discontinued their MHT in fear of becoming ill.

But some of the WHI researchers’ interpretations of the results were flawed. Later, more rational analyses of the trial results and subsequent studies proved that MHT, when used correctly and for the right woman, can be very beneficial.

Why the confusion? The women who took part in the WHI trial were all older and overweight, and many had existing heart disease. The study involved nearly 162,000 women, but their average age was 65 years. Some of them only started with MHT in their late 60s and even at 70. They also had to have no menopausal symptoms to get into the study. In other words, none of them were the typical woman who seeks treatment or support today.

When only those women who started MHT between 50 and 59 were analysed, the incidence of heart disease actually decreased after the first year of use and there was no increase in the number of strokes. Other studies have shown that the incidence of breast cancer didn’t increase in the first four years of MHT use.

Reviewed and updated by Dr Carol Thomas MBChB (UCT) FCOG (SA) MMed (O&G) (UCT), specialist gynaecologist in private practice, Cape Town, President of the South African Menopause Society and Director of the WomanSpace and iMobiMaMa. March 2017.

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