Conjugated equine estrogens and medroxyprogesterone have been the most commonly prescribed postmenopausal hormone therapy in the U.S. for women with a uterus and, until 2001-2002, had been used each day by more than six million women. It had been thought that the use of these agents would prevent cardiovascular disease, osteoporosis, and cancer in postmenopausal women during the aging process.

To confirm this theory scientifically, Congress mandated and the NIH established the Women’s Health Initiative (WHI) in 1991 to address the most common causes of death, disability, and impaired quality of life in postmenopausal women. The WHI, a 15-year, multimillion dollar endeavor and one of the largest U.S. prevention studies of its kind, addressed cardiovascular disease, cancer, and osteoporosis. The major components of the WHI were:
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1.  a randomized, controlled clinical trial of promising but unproven approaches to preventing disease.

2.  an observational study to identify predictors of disease.

3.  a study of community approaches to develop healthful behaviors.

The overall goal was to reduce coronary heart disease, breast and colorectal cancers, dementia, and osteoporotic fractures in postmenopausal women by using preventive strategies and identifying risk factors.

Women who had been randomly selected to receive active hormones were taking conjugated equine estrogens 0.625 mg each day and medroxyprogesterone acetate (progestin) (Prempro™, Wyeth) 2.5 mg each day. On May 31, 2002, the 10th interim analysis was conducted. At that time, the use of conjugated equine estrogens and medroxyprogesterone was observed to be associated with an increased risk of breast cancer. The additional findings of excess heart disease, stroke, and pulmonary embolism outweighed the evidence of the benefits.

It was concluded that the estrogen-progestin combination did not prevent heart disease in these women. For women taking the hormonal combination, the risks (increased breast cancer, heart attacks, strokes, and blood clots in the lungs and legs) outweighed the benefits (fewer hip fractures and colon cancers). After the WHI study results were published in 2002, an estimated 3 million women in the U.S. (a 50% decline) were taking the combined hormones. Viagra Online Canadian Pharmacy

During the first four years of the WHI, there was no difference in the rate of breast cancer development between women taking estrogen plus progestin and those taking placebo. After that time, the numbers began to increase; after an average of 5.2 years, the risk of breast cancer in healthy postmenopausal women taking estrogen-progestin therapy increased, compared with women taking placebo. Thus, the risk-benefit profile found in this trial was not consistent with the requirements for a viable intervention for primary prevention of chronic diseases, and the results suggested that this drug regimen should not be initiated or continued to prevent coronary heart disease.

In the WHI substudy of memory, older women who were taking combination hormone therapy had twice the rate of dementia, including Alzheimer’s disease, compared with women who were not taking the medication. In a study of women aged 65 and older, the risk of dementia was heightened in those who took estrogen-progestin therapy. This combination did not protect against the development of mild cognitive impairment, a form of cognitive decline that is less severe than dementia. Because of these newer findings, the National Institute on Aging recommended that combination hormone therapy should not be prescribed for older postmenopausal women to maintain or improve cognitive function.

CONCLUSION

The old cliche “You’ve come a long way, baby” is more meaningful in the world of medical research for women today than it has been in the last 100 years. Until recently, medical research has largely ignored many health issues important to women, and women have long been underrepresented in clinical trials. buy prescription drugs online

In the past, research on women’s health focused on diseases that affected fertility and reproduction, whereas many studies on other diseases focused exclusively on men. Today, most women receive diagnoses and treatment based on what has proved to be effective for men. However, the political efforts of women’s health advocates, the general public, and the unveiling of inequities in medical research have led to a broadened research agenda. Federal intervention and congressional legislative rules have begun to level the playing field. Research is beginning to yield insights into the health-related similarities and differences between men and women.