2024 review and update of the Women's Health Initiative

Hot Flush Fix Summary

Right, let's have a catch-up about the Women's Health Initiative – you know, that massive study that terrified an entire generation of women about hormone therapy back in 2002. The researchers have just published their final findings on the matter in May 2024, and they are rather more reassuring than you might expect.

For those who need a quick refresher: the WHI was this enormous study that followed over 68,000 women for up to 20 years, starting in the 1990s. When they stopped it early in 2002 because of increased breast cancer and heart disease risks, it sent shockwaves through the medical world. Suddenly, hormone therapy went from being widely prescribed to being treated like something you'd find under a rock.

However, 22 years of additional data and hindsight have taught us something else: the original findings were taken out of context. The new comprehensive review, published in JAMA (one of the most prestigious medical journals), provides the whole picture with two decades of follow-up.

The bottom line? Women younger than age 60 with low-to-average risk for cardiovascular disease and breast cancer who want to take hormone therapy may experience greater health benefits than risks during early menopause to treat moderate-to-severe symptoms, such as bothersome hot flushes or night sweats. It's all about timing – if you start hormone therapy close to menopause (within that famous "window of opportunity"), the benefits generally outweigh the risks.

The WHI study found that estrogen or a combination of estrogen and progestin had varying outcomes with chronic conditions, and the evidence does not support the use of these therapies to reduce risks for chronic diseases, such as heart disease, stroke, cancer, and dementia. But here's the crucial bit: the study was not designed to assess the effects of FDA-approved hormone therapies for treating menopausal symptoms, the benefits of which had been established before the WHI study began.

So basically, hormone therapy isn't a magic bullet for preventing heart disease or cancer (which is what they were originally testing). Still, it's excellent at what it was always meant to do – helping with menopause symptoms. The researchers emphasise that women ages 50 and older should work with their clinicians to make individualised and shared medical decisions, because one size definitely doesn't fit all.

The study also examined calcium and vitamin D supplements (which are not particularly effective for preventing hip fractures unless dietary intake is insufficient) and low-fat diets (which didn't prevent breast or colorectal cancer, although there may be some benefit for breast cancer mortality).

What this all means is that an entire generation of women may have been unnecessarily denied hormone therapy because of fears that were, frankly, overblown. The key is having an informed conversation with a knowledgeable doctor about your circumstances.

Just a friendly reminder: I'm sharing what I've learned, not prescribing what you should do. Always chat with your GP about what's right for your unique situation!