Hormone Therapies and Menopause: Where Do We Stand in the Post-WHI Era?

The WHI study, its premature termination, and controversy over its findings have motivated patientsand physicians alike to seek lower-dose therapies for menopausal symptoms. Substantial data indicate that low-dose ET/EPT is effective in treating osteoporosis, hot flushes, vulvaginal dryness anditching, and sleeping difficulties. Furthermore, low-dose therapies are associated with a decrease inbreast tenderness compared to standard dose therapies. Some risks associated with standard-doseHT diminish with low-dose treatments. Risk of stroke and venous thromboembolism, for example, fall to placebo levels with low-dose therapies. The nebulous effects on breast cancer and colorectalcancer rates, as well as on risk of CHD, point to the need for further study of low-dose therapies. Inlight of suggestions that timing of HT may play a role in a therapy’s efficacy and safety, more study ofperimenopausal and younger postmenopausal patients is warranted. Such therapy should bestarted as close to the onset of menopause as possible. In addition, recent data suggest that hormone therapy should currently be limited to the lowest dose possible for the duration of timeneeded to alleviate menopausal symptoms and should be in accordance with the patient’s medicalhistory and risk status.