Yorkshire Menopause Group

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10 years on from WHI - a statement on the state of the art from the BMS
18 July 2012

Nick Panay, BMS Chairman

10th July 2012

The Women’s Health Initiative Study1 had a profound effect on the use of HRT and therefore, the lives of millions of menopausal women.

It has now become clear that many of the risks in the WHI study occurred because the dose of HRT was too high for an elderly population of women with an average age of 63 years. There has also been critique as to whether the association with breast cancer was actually causal.2 It is imperative that these data are not extrapolated to a younger population of women going through the menopause in their late 40s and 50s and certainly not to women who have gone through a premature menopause

Unfortunately, many GPs are still concerned about prescribing HRT, particularly those qualified in the last 10 years since WHI reported. As a result many women are suffering menopause symptoms in silence, anxious about even approaching their GPs to discuss what the options are for optimising their menopause transition.

Information from the International Menopause Society in their 10 year post-WHI anniversary issue of Climacteric3 and the recent solidarity statement by the North American Menopause Society4 have highlighted concerns surrounding the premature way in which the WHI data were initially released and the subsequent damage to the lives of many thousands of menopausal women who were denied a safe intervention on spurious grounds.

The recommendations of the British Menopause Society / Women’s Health Concern (BMS/WHC) to the Department of Health are therefore timely. The key recommendation is that adequate resources should be allocated so that all women can have a discussion as to how they can optimise their menopause transition, with particular reference to lifestyle and diet and an opportunity to discuss the pros and cons of complementary therapies and HRT.5

Discussions are now taking place between the BMS/WHC and representatives of the Royal College of Obstetricians and Gynaecologists and the Royal College of General Practitioners to optimise the future dissemination of relevant evidence based information on menopause through primary and secondary care, thus helping to restore women’s confidence in proactively managing their menopause.

Key References

1) Writing group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomised controlled trial JAMA 2002; 288(3): 321-33.

2) Shapiro S, Farmer RD, Mueck AO, Seaman H, Stevenson JC. Does hormone replacement therapy cause breast cancer? An application of causal principles to three studies: part 2. The Women's Health Initiative: estrogen plus progestogen J Fam Plann Reprod Health Care 2011; 37(3): 165-72.

3) http://informahealthcare.com/toc/cmt/current accessed 10.07.12

4) http://www.menopause.org/pr0512whi.pdf accessed 10.07.12

5) British Menopause Society Council. Modernizing the NHS: observations and recommendations from the British Menopause Society. Menopause Int. 2011 Jun; 17(2):41-3.

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