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WHO calls for strong focus on Health Promotion for Women


16 July 2002

On 9 July 2002, one component of the Women's Health Initiative, a large study of the health effects of hormonal replacement therapy, was halted because post menopausal women who use a specific combination of estrogen and progestogen were found to be at increased risk for cardiovascular disease and breast cancer. While these women were also at reduced risk for hip fracture and colorectal cancer, the health risks for women using the combination therapy were determined to exceed the health benefits. The component of the study evaluating estrogen use without progestogen among women who have undergone hysterectomy continues and this study, when completed, is expected to provide more information regarding the balance of health risks and benefits for individual women considering the use of hormone replacement therapy.

The study investigators concluded that the risk-benefit profile for this specific combination of estrogen and progestogen "is not consistent with the requirements for a viable intervention for primary prevention of chronic diseases…"

However, proven, well-established and inexpensive measures for the prevention of diseases like osteoporosis, heart disease and cancer are a safe alternative for the prevention of chronic diseases, says the World Health Organization (WHO).

These preventive measures include tobacco cessation; adequate physical activity including weight-bearing exercises like walking; only moderate alcohol consumption for those who consume alcohol; and proper nutrition that includes a daily intake of at least five portions of fruits and vegetables and adequate levels of calcium and vitamin D. These measures empower women with the ability of improving and controlling their health, leaving critical decision-making in their own hands.

Osteoporosis affects an estimated 75 million people in the United States, Europe and Japan, including one in three post menopausal women. In women, the incidence of osteoporotic fractures increases after the age of 45 whereas in men the increase only occurs after the age of 75. As a result, the lifetime risk of these fractures in women is close to 40% while in men it is only 13%. Cardiovascular diseases killed almost nine million women in the year 2000; one in three women are killed by these diseases. More than one million women develop breast cancer every year, with a third eventually dying from it. All these conditions are growing problems in the developing world.

WHO says there are proven, safe and established measures that work to prevent heart disease and stroke. These include measures such as tobacco cessation, physical activity, healthy diets and, in countries where resources allow for it, screening and treatment of high blood pressure and high blood cholesterol. Women who follow these preventive guidelines have a substantially reduced risk of developing heart disease. Women who may have had a heart attack or stroke should also follow these preventive measures. In addition, they should consult their health care providers about taking aspirin (which helps thin the blood) and/or statins (which help cut down on fat in blood). These have been shown to further reduce their risk of a recurrence of cardiac events.

The study results point to an increased risk of developing breast cancer for women on this combined hormonal replacement treatment. This reinforces the general importance of breast cancer screening by mammography for all women over 50 years of age, a recommendation endorsed by WHO as proven to reduce breast cancer mortality.

For women who are currently on hormonal treatment for the prevention of osteoporosis and who are considering stopping, WHO recommends they consult their physicians about an alternative treatment since stopping hormones abruptly will lead to a resumption of bone loss. Any change in medication must be closely supervised by a medical professional. The need to consult their physicians also applies to all women who are under the therapy which has now been halted.

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For more information contact:

Ms Helen Green
Telephone: +41 (22) 791 3432
Mobile phone: +41 (79) 475 5572
Fax: +41 (22) 791 4832
E-mail: greenh@who.int