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Postmenopausal Women and Hormones

Abstract
Objectives: To analyze scientific integrity, educational qualities, objectivity, and subject matter control of the educational manuscript of the "Women, hormones, and therapy: New observations from the Women's Health Initiative and Nurses' Health Study." Data sources: All pertinent English-language scientific publications have been recognized by using Medical Subject Headings (MeSH), which were selected and used in a search on MEDLINE (1998 - March 2007), ACOG online database (1998 - March 2007), HealthSTAR (1998 - March 2007), Cochrane Library database (1998 - March 2007). All the published materials relevant to the Women's Health Initiative (WHI) studies were included for review. Also, Reference lists of significant articles as well as a manual search of key articles were incorporated into this report. The manuscript entitled "Women, hormones, and therapy: New observations from the Women's Health Initiative and Nurses' Health Study" (Simon et all, Publisher: Medical Education Group LLC, Trevose, PA, U.S.A., 2007) has been systematically reviewed. Method of study selections: Altogether, 391 studies were reviewed and compared to "Women, hormones, and therapy: New observations from the Women's Health Initiative and Nurses' Health Stud (2007)" publication offered as a CME educational update for obstetricians/gynecologists (Simon et all ³, Publisher: Medical Education Group LLC, Trevose, PA, U.S.A.) were scientifically scrutinized. In addition to, the original WHI study (2002) and the WHI Steering Committee (2004), and Hsia et all WHI (2006) publications were reviewed. The published HRT and ERT, and WHI articles were included for this review. Inclusion criteria for this review were based upon published studies, if they enclosed a scientific evaluation of the designed, method and statistics of the WHI study. Exclusion criteria were applied to those publications which were analyzed the WHI study's results without scientific scrutiny of the WHI study's methodology and statistics. Tabulation, integration, and results: The "Women, hormones, and therapy: New observations from the Women's Health Initiative and Nurses' Health Study" CME educational manuscript offered the following didactic objectives: 1) The use of conjugated equine estrogen (CEE) 0.625 mg daily by postmenopausal women with prior hysterectomy reviled notable difference when the results were examined by the group age: Group I, age between 50 and 59 years, no significant trend for reducing the risk of myocardial infarct (MI) or coronary death. Group II, age between 60 and 79 years, there was statistically significant reduction in the risk of coronary revascularization and did not reduce the risk of MI or other coronary forms of CHD. 2) The use of CEE may lower the CHD risk in younger postmenopausal women. 3) Younger postmenopausal women are good candidates for initiating hormone therapy. 4) Breast cancer risk should not be of concern during short-term of management of menopausal symptoms, because the increase in risk seen in the WHI only became evident after 4 years of treatment. 5) HRT or CEE provides reassurance for the use of hormonal therapy in recent menopausal women with vasomotor symptoms. 6) Hormone therapy in women receiving statins is not contraindicated. 7) Resuming Hormone therapy is reasonable at the low dose. 8) The prior thromboembolic event related to immobilization or trauma doesn't constitute contraindication for the use a non-oral formulation of hormone therapy. 9) The WHI data should provide assurance for the cardiovascular safety of hormone therapy in recently menopausal women. The results of other studies have documented that WHI study's design, method, and statistical analysis failure to support results and conclusions of the WHI clinical trial. Conclusions: The educational manuscript did not meet criteria as a didactic material for gynecologists due to: 1) Scientific data were inadequately selected. 2) Bias interpretation of the pertinent data of the WHI study. 3) Deficient in balancing current available knowledge related to the WHI study. 4) Objectivity of the publication is cloudy throughout the manuscript. 5) No rigid adherence to the intended subject matter.

Key words
hormone replacement therapy, estrogen replacement therapy, menopause, postmenopause, vasomotor symptoms

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