#253 ‒ Hormone replacement therapy and the Women’s Health Initiative: re-examining the results, the link to breast cancer, and weighing the risk vs reward of HRT | JoAnn Manson, M.D.

55 snips

May 8, 2023

JoAnn Manson, a prestigious endocrinologist and epidemiologist, unravels the complexities surrounding hormone replacement therapy (HRT) and its controversial link to breast cancer. She highlights misinterpretations from the Women’s Health Initiative that skewed public perception and discusses the nuanced risks and benefits of HRT. JoAnn also examines the role of estrogen in breast cancer risk, advocating for personalized treatment approaches. With insights into the importance of individualized assessments, she aims to reshape how physicians approach HRT in practice.

Ask episode

AI Snips

Chapters

Transcript

Episode notes

INSIGHT

Observational Studies and HRT

Observational studies, like the Nurses' Health Study, suggested hormone replacement therapy (HRT) lowered heart disease risk.
However, these studies couldn't prove causality due to potential confounding factors like socioeconomic status and access to healthcare.

INSIGHT

Common HRT Formulations

In the 1990s, conjugated equine estrogen (CEE), with/without medroxyprogesterone acetate (MPA), were the most common HRT formulations.
CEE dominance may be due to a pharmaceutical company's early development and marketing, while estradiol synthesis from plants was less prevalent.

INSIGHT

WHI Inclusion/Exclusion Criteria

The Women's Health Initiative (WHI) included women aged 50-79, mean age 63.
Women with prior breast/endometrial cancer, recent heart attack/stroke, or estrogen-sensitive cancers were excluded.

Get the Snipd Podcast app to discover more snips from this episode

Get the app

View the Show Notes Page for This Episode

Become a Member to Receive Exclusive Content

JoAnn Manson is a world-renowned endocrinologist, epidemiologist, and Principal Investigator for the Women’s Health Initiative (WHI). In this episode, she dives deep into the WHI to explain the study design, primary outcome, confounding factors, and nuanced benefits and risks of hormone replacement therapy (HRT). JoAnn reflects on how a misinterpretation of the results, combined with sensationalized headlines regarding an elevated risk of breast cancer, led to a significant shift in the perception and utilization of HRT. From there, they take a closer look at the breast cancer data to separate fact from fiction. Additionally, JoAnn gives her take on how one should weigh the risks and benefits of HRT and concludes with a discussion on how physicians can move towards better HRT practices.

We discuss:

The Women’s Health Initiative: the original goal of the study, hormone formulations used, and potential confounders [4:15];
Study design of the Women’s Health Initiative, primary outcome, and more [16:00];
JoAnn’s personal hypothesis about the ability of hormone replacement therapy to reduce heart disease risk prior to the WHI [26:45];
The relationship between estrogen and breast cancer [30:45];
Why the WHI study was stopped early, and the dramatic change in the perception and use of HRT due to the alleged increase in breast cancer risk [37:30];
What Peter finds most troubling about the mainstream view of HRT and a more nuanced look at the benefits and risks of HRT [45:15];
HRT and bone health [56:00];
The importance of timing when it comes to HRT, the best use cases, and advice on finding a clinician [59:30];
A discussion on the potential impact of HRT on mortality and a thought experiment on a long-duration use of HRT [1:03:15];
Moving toward better HRT practices, and the need for more studies [1:10:00]; and
More.

Connect With Peter on Twitter, Instagram, Facebook and YouTube