NEW YORK (Reuters Health) – A further analysis of data from the Women’s Health Initiative (WHI) trials indicates that the risks of hormone therapy still generally outweigh the benefits, even when initiated soon after menopause.

WHI trials examining the use of conjugated equine estrogens (CEE) with or without medroxyprogesterone acetate (MPA) were stopped early in 2002 and 2004, respectively, after these interventions were linked to increased risks of breast cancer and stroke and appeared to provide little benefit for heart disease.

Whether relatively short-term hormone therapy started soon after menopause could yield a better risk:benefit ratio was unclear, according to the report in the American Journal of Epidemiology for July 1.

To investigate, Dr. Ross L. Prentice, from the Fred Hutchinson Cancer Research Center, Seattle, and colleagues analyzed data from the initial WHI randomized trials as well as from the WHI observational study, which ran from 1993 to 2004 and featured 93,676 postmenopausal women.

Initiation of CEE alone or with MPA soon after menopause increased the risk of total cancer and breast cancer (p < 0.05). Both regimens were also linked to an increased risk of venous thromboembolism and stroke and with a decreased risk of hip fracture. “These analyses provide little support for the hypothesis of favorable effects among women who initiate postmenopausal estrogen use soon after menopause, either for coronary heart disease or for health benefits versus risk indices considered,” the authors conclude. The results seen in the CEE/MPA trial as a whole appear to apply to recently postmenopausal women. Reference:
Am J Epidemiol 2009;170:12-23.