The impact of the women's health initiative on the search for improved treatments for the conditions associated with long-term oestrogen deprivation
Publication of the preliminary findings from the combination (oestrogen and progestogen) hormone therapy (HT) arm of the Women's Health Initiative (WHI) on the heels of the Heart and Estrogen/progestin Replacement Study (HERS) sent the field of menopausal medicine into turmoil. It is now considered that oestrogen therapy (ET)/HT should be used only to treat the shortterm climacteric conditions associated with menopause and that its use to treat conditions associated with long-term oestrogen deprivation (ie, cardiovascular disease, osteoporosis and delay of the onset of dementia and Alzheimer's disease) is no longer appropriate. As a result, there has been a dramatic decrease in the number of patients using ET/HT. With few new therapeutic options on the horizon to treat either the short or long-term consequences of oestrogen deprivation, it seems that progress in the treatment of the menopausal patient has taken a large step backwards. This review considers how the direction of research in the field of menopausal medicine has been shaped by the WHI and outlines what the future might hold.