Effects of Menopausal Hormone Therapy, Calcium Plus Vitamin D Supplementation, and Dietary Modification

The US Women’s Health Initiative (WHI) clinical trial results do not support hormone therapy with oral conjugated equine estrogens plus medroxyprogesterone acetate for postmenopausal women or conjugated equine estrogens alone for those with prior hysterectomy to prevent cardiovascular disease, dementia, or other chronic diseases. However, hormone therapy is effective for treating moderate to severe vasomotor and other menopausal symptoms. These benefits of hormone therapy in early menopause, combined with lower rates of adverse effects of hormone therapy in early compared with later menopause, support initiation of hormone therapy before age 60 years for women without contraindications to hormone therapy who have bothersome menopausal symptoms. The WHI results do not support routinely recommending calcium plus vitamin D supplementation for fracture prevention in all postmenopausal women. However, calcium and vitamin D are appropriate for women who do not meet national guidelines for recommended intakes of these nutrients through diet. A low-fat dietary pattern with increased fruit, vegetable, and grain consumption did not prevent the primary outcomes of breast or colorectal cancer but was associated with lower rates of the secondary outcome of breast cancer mortality during long-term follow-up. The WHI enrolled 161 808 postmenopausal women (N = 68 132 in the clinical trials) aged 50 to 79 years at baseline from 1993 to 1998 and followed them up for up to 20 years. The trial of estrogen plus progestin was stopped early per recommendation, after a median follow-up of 5.6 years because risks outweighed benefits. Source: https://jamanetwork.com/