The excess risk of breast cancer with long-term use (10 years) of 19/1000 EPT and 5/1000 for ET alone can be compared with the excess risk of endometrial cancer after 10 years use of ET alone of 10/1000. Ten years of EPT is estimated to result in no increased risk of endometrial cancer.

Since the Million Women study shows a greater risk of breast cancer with combined EPT, women and their physicians will need to weigh the possibility that the increased risk of breast cancer caused by the addition of a progestogen is greater than the risk of endometrial cancer with estrogen only. If this is correct, the logical conclusion may be that women should be advised to take estrogen alone for hormonal therapy, even if they have a uterus and that screening be instituted for endometrial cancer. This possibility would need extensive discussion before making a general recommendation. Other options include using progestogen delivery systems that allow a local progestogen effect at the uterus.

Because this is an observational study, it has potential for error. According to Utian and colleagues6, the major weakness is that the study took only a snapshot of hormone therapy use at the time of entry into the study, when women had their every third year mammogram. No further information was obtained about changes in hormones, route, dose, or discontinuation.

In conclusion, the Million Women Study serves as a large observational study that confirms the WHI findings of a small increase in absolute risk of breast cancer with EPT therapy, and confirms prior observational studies of a smaller increase in absolute risk of breast cancer with ET. These findings are important to convey to women making decisions about initiation or continuation of hormone therapy. The findings do not change current recommendations to use hormones primarily for menopausal symptom relief, vulvovaginal atrophy, and quality of life issues in symptomatic menopausal women with natural, premature, or surgically induced menopause.

They support current recommendations from the North American Menopause Society (NAMS)7, American College of Obstetrics and Gynecology (ACOG),8 and the Food and Drug Administration (FDA)9,10 to use the lowest, most effective dose for the shortest period of time.

Recent media accounts of the findings from the HT trials of the Women’s Health Initiative (WHI) have increased women’s concerns about using hormones for relief from menopausal symptoms and have heightened the need for clinicians to take a more individualized approach to counseling their menopausal patients.

CME program, Scientific Update on Hormones and Postmenopausal Health, is designed to assist clinicians in providing their patients with accurate information and individualized counseling about menopausal health issues and HT. This slide series allows physicians to earn a maximum of 1 category 1 credit per presentation toward the American Medical Association’s Physician’s Recognition Award (AMA-PRA) through the University of Wisconsin Medical School.

Women have given HRT a fair trial and rejected it. Not to take their HRT is almost as bad as smoking. Why, they will get heart disease like men do (though probably fewer thrombo-embolic disorders). They will die younger without HRT, goes the argument, which does not go so far as to point out that this represents a valuable service for the public health authorities. It is unthinkable that women would not be delighted to live out their lives dependent upon chemotherapy supplied at a price by the pharmaceutical biochemical superpowers.

Modern women are much more highly estrogenized than their recent ancestors. An zoologist from Oxford calculated that over a mere 200 years the average number of menstrual cycles experienced by a European woman in her lifetime had increased from about thirty to 450. Her calculation is based upon the menarche’s occurring earlier and upon the infrequent pregnancies that modern women can expect to carry to term together with shorter periods of lactation. If we add to this the artificially estrogenized condition of modern woman post-menopause we end up with an astonishing 600 or so cycles. There is no precedent in the history of the human female for the raised and sharply fluctuating levels of circulating steroid hormones that we endure but, as we did not know what made the nineteenth-century female feel well or even if she felt well, we can hardly guess whether the modern women is better or worse off because of her vastly altered endocrinology. Only the rising cancer figures tell us that she is worse off.

How you answer the question, whether individuals should be persuaded to live their whole lives in a state of chemical dependency, first upon contraceptive steroids and then on replacement therapy, depends upon your regard for the autonomy of the individual. If men would not live their lives this way, why should women? Even though all teenagers should by now be convinced that condoms should be their contraceptives of choice, British physicians have begun lobbying for the right to prescribe synthetic sex steroids to women under sixteen. The caponized woman is now the norm.

They went back to natural estrogen, a cumbersome and expensive product, harvested from the urine of pregnant mares. The mares are fitted with a collection cup attached to a hose and confined in a narrow stall for the entire eleven months of their pregnancy. As soon as possible after the birth of their foals, who are routinely slaughtered, the mares are re-impregnated and the urine-collection process begins again.

If the pharmaceutical companies were to get women hooked the best time was at menopause when they were in estrogen withdrawal and begging for a fix. At least that was what the researchers thought that hot flushes, joint pains, sleeplessness, etc., added up to. The new mixtures were the methadone rather than the heroin. For some reason the women did not stay hooked. The selling and the product design were relaunched time and again. Sub-dermal implants seemed to lose their effectiveness; women required bigger closes, the implants became ineffective more quickly, menopausal symptoms recurred at shortening intervals. The manufacturers of sex steroid preparations, like the manufacturers of cigarettes, had what they wanted, addiction, and they were just as unwilling to talk about it. An underground network of pushers w-as set up; women, all users themselves, held HRT parties, bring-and-buy sales and coffee mornings, to spread awareness so that women would ask their doctors to prescribe.

Women who take estrogen definitely tend to look younger than their years. Their skin remains smoother, moister, oilier and more flexible – in other words younger. That doesn’t mean you should take estrogen for cosmetic purposes alone. Younger-looking skin is just one of the magical consequences of HRT that researchers have been unable to substantiate; as far as laboratory investigations can establish, exogenous estrogen has no effect on the epidermis or supporting structures.