#253 ‒ Hormone replacement therapy and the Women’s Health Initiative: re-examining the results, the link to breast cancer, and weighing the risk vs reward of HRT | JoAnn Manson, M.D.

The Peter Attia Drive

Peter Attia, MD

Health & Fitness, Medicine, Fitness

4.7 • 7.3K Ratings

🗓️ 8 May 2023

⏱️ 81 minutes

🔗️ Recording | iTunes | RSS

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Summary

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JoAnn Manson is a world-renowned endocrinologist, epidemiologist, and Principal Investigator for the Women’s Health Initiative (WHI). In this episode, she dives deep into the WHI to explain the study design, primary outcome, confounding factors, and nuanced benefits and risks of hormone replacement therapy (HRT). JoAnn reflects on how a misinterpretation of the results, combined with sensationalized headlines regarding an elevated risk of breast cancer, led to a significant shift in the perception and utilization of HRT. From there, they take a closer look at the breast cancer data to separate fact from fiction. Additionally, JoAnn gives her take on how one should weigh the risks and benefits of HRT and concludes with a discussion on how physicians can move towards better HRT practices.

We discuss:

The Women’s Health Initiative: the original goal of the study, hormone formulations used, and potential confounders [4:15];
Study design of the Women’s Health Initiative, primary outcome, and more [16:00];
JoAnn’s personal hypothesis about the ability of hormone replacement therapy to reduce heart disease risk prior to the WHI [26:45];
The relationship between estrogen and breast cancer [30:45];
Why the WHI study was stopped early, and the dramatic change in the perception and use of HRT due to the alleged increase in breast cancer risk [37:30];
What Peter finds most troubling about the mainstream view of HRT and a more nuanced look at the benefits and risks of HRT [45:15];
HRT and bone health [56:00];
The importance of timing when it comes to HRT, the best use cases, and advice on finding a clinician [59:30];
A discussion on the potential impact of HRT on mortality and a thought experiment on a long-duration use of HRT [1:03:15];
Moving toward better HRT practices, and the need for more studies [1:10:00]; and
More.

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Transcript

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0:00.0	Hey everyone, welcome to the Drive Podcast.
0:13.0	I'm your host, Peter Atia.
0:14.8	This podcast, my website, and my weekly newsletter, I'll focus on the goal of translating
0:18.7	the science of longevity into something accessible for everyone.
0:22.4	Our goal is to provide the best content in health and wellness, full stop, and we've
0:26.6	assembled a great team of analysts to make this happen.
0:29.4	If you enjoy this podcast, we've created a membership program that brings you far more
0:33.2	in-depth content if you want to take your knowledge of the space to the next level.
0:37.3	At the end of this episode, I'll explain what those benefits are, or if you want to learn
0:41.1	more now, head over to peteratiamd.com forward slash subscribe.
0:46.3	Now, without further delay, here's today's episode.
0:51.0	My guess this week is Dr. Joanne Manson.
0:54.1	Joanne is a professor of medicine and the Michael and Lee Bell professor of women's health
0:59.6	at Harvard Medical School, professor in the Department of Epidemiology, along with chief
1:04.5	of the Division of Prevention Medicine at Brigham and Women's Hospital.
1:09.4	She is also a physician epidemiologist, endocrinologist, and the principal investigator or
1:13.8	co-PI of several research studies, including Women's Health Initiative, which we of course
1:18.8	discuss here in length, along with other studies such as the cardiovascular components
1:23.0	of the nurse's health study, the vitamin D, and omega-3 trial known as vital.
1:28.6	Her primary research interests include randomized clinical prevention trials of nutrition and
1:33.4	lifestyle factors related to heart disease, diabetes, cancer, and the role of endogenous
1:38.0	and exogenous estrogens as determinants of chronic disease in women.
	...

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