No increased death toll for long-term menopausal hormone therapy

It took many years since the initial publication of data from the Women’s Health Initiative (WHI) study until further analyses and additional accumulated clinical information allowed realization of the full scope of its results. At first, the focus was on morbidity, mainly the slightly higher incidence of cardiovascular events and breast cancer cases among postmenopausal hormone users. Then, the age factor became evident, and the good safety profile of hormone therapy in healthy women initiating treatment near menopause and using it for up to 10 years eased the previous concerns. Now, 15 years after the first release of the WHI data, long-term follow-up of the WHI cohort enables consideration of mortality records as well. These data were recently summarized by the WHI investigators as follows: ‘Among postmenopausal women, hormone therapy with CEE plus MPA for a median of 5.6 years or with CEE alone for a median of 7.2 years was not associated with risk of all-cause, cardiovascular, or cancer mortality during a cumulative follow-up of 18 years.’ It seems that the bitter debate on the hazards of postmenopausal hormone therapy has come to an end, since the existing database permits clear and rationalized prescribing decisions.