About eight years ago important medical journals suddenly started publishing articles advising post-menopausal women not to take hormonal therapy (HT, consisting of estrogen and progestin). If this news was hard to comprehend for doctors, the public was even more confused. Until this stunning piece of news, most Western-trained doctors were telling post-menopausal women to conscientiously take HT pills because they would be protected from osteoporosis (weak, mineral-deficient bones), cardiovascular (heart attacks) and a whole host of other illnesses. Drug companies making these pills (premarin, for example) were obviously delighted.

However, there was not enough evidence to back these claims about the protective effects of HT. Because estrogen and progestin levels decrease after menopause, the whole idea of replenishing these hormones in tablet form made great, intuitive sense. Except that often times in medicine, intuitive sense does not always translate to good outcome.

Indeed, in 2004 the Women's Health Initiative (WHI) based in the US came up with startling findings about the serious side effects of administering HT to postmenopausal women. The study recruited 27,000 postmenopausal women to perform a definitive study and what caught everybody by surprise were the incredible side-effects. It revealed that HT decreased hip fracture by 34 per cent in the women. A good thing, and no one was surprised. But concurrently this study revealed a string of bad news for this cohort of women who had been followed for 5-7 years: there was a 30 per cent increase in heart attacks, 40 per cent increase in strokes, 25 per cent increase in breast cancer and 100 per cent increase in deep vein thrombosis.

In fact the preliminary findings were so unacceptable that the study was stopped early so that the participants could stop taking estrogen and not be potentially risking the complications of HT. Aborting the study was also in keeping with a Hippocratic oath which states: above all, do no harm (Primum non nocere in Latin ). I must hasten to add that not all postmenopausal women behave similarly, and it may be good to discuss your personal situation with your doctor.

The WHI program established in 1991 continues to do exemplary work in postmenopausal problems and often comes up with findings that challenge conventional wisdom so that doctors may better serve their patients. The HT study is a good example of this.