MENSTRUATION MATTERS

On June 24, the Journal of the American Medical Association (JAMA) released a report on the Women’s Health Initiative Memory Study of Younger Women (WHIMSY) in the JAMA Network publication JAMA Internal Medicine.

This study is of particular interest because hormone therapy caused significant deficits in cognitive functioning in women aged 65 and older, as documented in the Women’s Health Initiative Memory Study (WHIMS). The “Timing Hypothesis” proposes that, despite the serious risks of hormone therapy demonstrated in the Women’s Health Initiative (WHI) research, therapy with conjugated equine estrogens can benefit women when it is started during the menopausal transition and in early menopause. Last year, a position paper endorsed by 14 medical societies made that claim (Stuenkel, et al, 2012).

Why would so many in the medical profession continue to prescribe hormone therapy, and to believe that hormone therapy is beneficial, in the face of powerful evidence that the risks of such therapy far outweigh the benefits? Probably several reasons:

1) Few other therapies are as effective in relieving women who suffer from distressing symptoms during and after the menopausal transition.

2) Animal and laboratory studies strongly support a positive role for estrogen in cognitive function.

3) The pharmaceutical industry wields tremendous power, and provides financial support to most of the medical societies and research studies in this area.

 It is, as the authors state, “reassuring” that this latest WHIMSY study found neither increased risk nor increased benefit in cognitive assessments an average of 7 years after the study was halted, among the 1,272 participants in the WHI who were 50 to 55 years old when the hormonal therapy was started. However, the lack of cognitive benefit makes one wonder why women would want to risk the serious consequences associated with hormone therapy.

Advocates for women’s health must continue to challenge the ethical and scientific basis for medical practices that can potentially be harmful to women. We need to support research on the mechanisms underlying the effects of hormones on women’s bodies, but also on the sociopolitical forces influencing medical practice.

 

Stuenkel, Cynthia A., Margery L. S. Gass, JoAnn E. Manson, Rogerio A. Lobo, Lubna Pal, Robert W. Rebar, and Janet E. Hall. “A decade after the Women’s Health Initiative—the experts do agree.” Menopause: The Journal of the North American Menopause Society 19.8 (2012): 846–847.

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