Postmenopausal hormone therapy: New questions and the case for new clinical trials

Jo Ann E. Manson, Shari S. Bassuk, S. Mitchell Harman, Eliot A. Brinton, Marcelle I. Cedars, Rogerio Lobo, George R. Merriam, Virginia M. Miller, Frederick Naftolin, Nanette Santoro

Research output: Contribution to journalReview article

79 Scopus citations

Abstract

Observational studies suggest that postmenopausal hormone therapy (HT) prevents coronary heart disease, whereas randomized clinical trials have not confirmed a cardioprotective effect. Although observational studies may have overestimated the coronary benefit conferred by postmenopausal hormone use, there are other plausible explanations for the apparent discrepancy between previous results and the less favorable findings from clinical trials such as the large Women's Health Initiative. There is now a critical mass of data to support the hypothesis that age or time since menopause may importantly influence the benefit-risk ratio associated with HT, especially with respect to cardiovascular outcomes, and that the method of administration, dose, and formulation of exogenous hormones may also be relevant. Although the weight of the evidence indicates that older women and those with subclinical or overt coronary heart disease should not take HT, estrogen remains the most effective treatment currently available for vasomotor symptoms, and its effects on the development of coronary disease in newly postmenopausal women remain unclear. Moreover, effects of HT on quality of life and cognitive function in recently postmenopausal women merit further study. These unresolved clinical issues provide the rationale for the design of the Kronos Early Estrogen Prevention Study, a 5-year randomized trial that will evaluate the effectiveness of low-dose oral estrogen and transdermal estradiol in preventing progression of atherosclerosis in recently postmenopausal women.

Original languageEnglish (US)
Pages (from-to)139-147
Number of pages9
JournalMenopause
Volume13
Issue number1
DOIs
StatePublished - Jan 1 2006

Keywords

  • Atherosclerosis
  • Clinical trials
  • Coronary heart disease
  • Estrogen
  • Observational studies
  • Postmenopausal hormone therapy

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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    Manson, J. A. E., Bassuk, S. S., Harman, S. M., Brinton, E. A., Cedars, M. I., Lobo, R., Merriam, G. R., Miller, V. M., Naftolin, F., & Santoro, N. (2006). Postmenopausal hormone therapy: New questions and the case for new clinical trials. Menopause, 13(1), 139-147. https://doi.org/10.1097/01.gme.0000177906.94515.ff