One of the principal problems in menopause care lies in the fact that a number of major allopathic studies have come to, at times, contradictory results. For that reason, we want to summarize what some of these studies concluded and, at the same time, add some relevant commentary:

The Women’s Health Initiative published two distinctive studies. In a first study 16,608 postmenopausal women took either a hormone combination of estrogen and progestin or sugar pills (i.e., placebo). What is important to note, and will be discussed in more detail later, these women were all truly postmenopausal, at ages 50-79 years. In practical terms this means that no younger, and only perimenopausal (for definition, see Menopause Terminology) women were included, who usually represent the age group with most symptoms.

This study concluded that the use of estrogen, in combination with a progestin, increases the risk of breast cancer, stroke, blood clots in legs and lungs ( so called life-threatening pulmonary emboli) and heart attacks during their first year of treatment. Maybe most importantly, however, the treatment demonstrated no protective effect whatsoever from heart disease, as had been assumed up to that point.

Because of these findings, and despite additional findings which suggested that treatment decreased bone fractures and appeared to decrease the risk of colon cancer, this study was halted in 2002 because an ethics committee considered it no longer ethical to continue the treatment group on their treatment.

In a second study, once again involving only postmenopausal women, at ages 50 through 79, 10,739 women were either treated with only estrogen or with placebo. Once again, the findings were surprising:

Women in the treatment group showed an increased risk for stroke and blood clots in their legs. There was neither an increased risk, nor a benefit, in regards to heart disease (i.e., heart attacks), breast cancer and colorectal cancer; but treatment did reduce bone fractures. Because of these findings, this study was stopped in 2004.

The results from these two studies resulted in a revolution in postmenopausal care. Many dogmas, equally cherished by the medical profession and the lay public, were suddenly considered disproved. As a consequence, the utilization of hormone replacement therapy (HRT) plummeted and many patients (and physicians) were left wondering what to do. Amongst dogmas that were now widely considered as abandoned, was the believes that HRT was cardio-protective; i.e., reduced the risk of heart attacks. Indeed, suddenly, the data appeared to demonstrate exactly the opposite: the risk of heart disease may be increased, as is the risk of stroke, pulmonary embolism and breast cancer. And all of these risks appear to greatly outweigh the potential benefits of HRT, primarily its effect on osteoporosis and bone fractures.

As practice patterns evolved as a consequence of the Women’s Health Initiative, an increasing number of authorities started to question the conclusions of above cited two studies. The Women’s Health Initiative was designed to study an older group of patients. When the various studies were initially designed, most physicians (and investigators) believed that HRT would benefit women at any age. This was, however, disproved by these studies. Indeed, everybody now accepts that HRT does not improve overall health for women well beyond menopause.

Since the results from these two studies were published, many in the scientific Community have started wondering, however, whether HRT might not be more beneficial at a younger age, during the so-called perimenopausal period, when women evidence the first symptoms of decreased ovarian function. Since older women are only rarely symptomatic, the risk benefit consideration for the use of HRT in them might be different from younger women who quite frequently suffer from menopausal symptoms.

And, indeed, a more recent study, published in The Journal for Women’s Health, (and reported in detail in an article in The New York Times on January 31, 2006) conducted in younger, primarily perimenopausal women, resulted in very different results and suggested an approximately 30% decrease of coronary hear disease after HRT. It, therefore, now appears that HRT in younger women, during approximately the first 10 years after symptoms appear, may not only not be associated with increased cardiovascular and embolic risks, but, indeed, may be cardio-protective, as has been assumed for so may years before the data from the Women’s Health Initiative were published. In contrast, women, for longer periods in menopause, indeed, show the risks reported in these two earlier studies by the Women’s Health Initiative.

What all of this, of course, means is that the treatment of menopause is more complicated than has been assumed for a long time and that treatment, therefore, has to be individualized! As a consequence, the correct treatment of menopause, which almost for decades has been dogmatically static, suddenly has evolved into a complex amalgam of options, calling for individualization and special attention to detail. MRI was founded to serve these needs, as an ever larger number of baby boomers find themselves facing the problems and symptoms of menopause.