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Hormone Replacement Therapy: Real Concerns and False Alarms

Bluming, Avrum Z. MD; Tavris, Carol PhD

doi: 10.1097/PPO.0b013e31819e332a
Review Article

From 2002 to 2008, reports from the Women’s Health Initiative (WHI) claimed that hormone replacement therapy (HRT) significantly increased the risks of breast cancer development, cardiac events, Alzheimer disease, and stroke. These claims alarmed the public and health professionals alike, causing an almost immediate and sharp decline in the numbers of women receiving HRT. However, the actual data in the published WHI articles reveal that the findings reported in press releases and interviews of the principal investigators were often distorted, oversimplified, or wrong. This review highlights the history of research on HRT, including a timeline of studies that have or have not found a link between HRT and breast cancer; discusses how to distinguish important, robust findings from those that are trivial; closely examines the WHI findings on HRT and breast cancer, most of which are weak or statistically insignificant; reviews the current thinking about possible links of HRT with cardiovascular disease and cognitive functioning; and reports research on the benefits of HRT, notably relief of menopausal symptoms, that affect a woman’s quality of life. On these complicated matters, physicians and the public must be cautious about accepting “findings by press release” in determining whether to prescribe or take HRT.

Dr. Bluming is a Master of the American College of Physicians, a Clinical Professor of Medicine at the University of Southern California, a former senior investigator for the National Cancer Institute and an oncologist in private practice. Dr. Tavris is a social psychologist, writer, and lecturer, fellow of the Association for Psychological Science, coauthor of two leading psychology textbooks and, most recently, of Mistakes Were Made (But Not by Me) (with Elliot Aronson). The reader should know that neither of us has any vested interest in defending the pharmaceutical industry nor have we accepted compensation for writing this article; indeed, one of us (CT) has been a vociferous critic of the industry’s often-biased research.

Received for publication January 5, 2009; accepted January 27, 2009.

Reprints: Avrum Z. Bluming, MD, 16133 Ventura Boulevard, Suite 470, Encino, CA 91436. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.