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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EIn 2002, a landmark report from the Women\u0027s Health Initiative (WHI) led to a widespread halt in the prescribing of hormone treatment for postmenopausal women when the study showed that serious risks outweighed benefits when the treatment was used for chronic disease prevention. Nine years later, the use of hormone therapy for postmenopausal women remains a complex and challenging topic.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHormone Therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMenopause\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EIn 2002, a landmark report from the Women\u0027s Health Initiative (WHI) led to a widespread halt in the prescribing of hormone treatment for postmenopausal women when the study showed that serious risks outweighed benefits when the treatment was used for chronic disease prevention. Nine years later, the use of hormone therapy for postmenopausal women remains a complex and challenging topic.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003E\u201cMany clinicians have decided not to prescribe hormone therapy for their patients,\u201d said JoAnn E. Manson, MD, DrPH, FACE, Brigham and Women\u0027s Hospital, Harvard Medical School, Boston, Massachusetts, USA, one of the principal investigators for the WHI. Dr. Manson added that researchers have \u201clearned a lot since 2002\u201d and noted that hormone therapy still has a clinical role in the treatment of moderate-to-severe menopausal symptoms.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003E\u201cHormone therapy is neither good nor bad for all women, and it is very clear that there is no one- size-fits-all answer for clinical decision-making,\u201d said Dr. Manson. She pointed to age and time since menopause as major factors that can help identify women who are good or poor candidates for hormone therapy, especially with regard to the risk for coronary heart disease (CHD).\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EThe Women\u0027s Health Initiative Trials\u003C\/h2\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe WHI Hormone Therapy Trials were designed to assess the role of menopausal hormone therapy in chronic disease prevention. The WHI Estrogen + Progestin (E+P) Trial was stopped more than 3 years early when it became clear that the risks of treatment\u2014increased risks for breast cancer (26%), CHD (29%), stroke (41%), and pulmonary embolism (113%)\u2014far outweighed the benefits of decreased risks for hip fracture (34%) and colorectal cancer (34%) [Writing Group for the Women\u0027s Health Initiative. \u003Cem\u003EJAMA\u003C\/em\u003E 2002]. The WHI Estrogen-Alone (E-alone) trial was also stopped early, with findings of a 39% increased risk for stroke. Although estrogen had a neutral effect on other risks, \u201cit was still not a good tradeoff for chronic disease prevention,\u201d said Dr. Manson.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EThe WHI findings regarding CHD risks conflicted with the results of previous observational studies of postmenopausal hormone therapy. Dr. Manson said that more than 40 observational studies of hormone therapy had shown that the relative risks of CHD were 40% to 50% lower among current or ever-users of hormone therapy compared with never-users [Grodstein F et al. \u003Cem\u003EProg Cardiovasc Dis\u003C\/em\u003E 1995]. \u201cThis percentage was probably an overestimate of the benefit, but confounding and selection biases that may influence observational studies may not have been the only factors,\u201d said Dr. Manson. She pointed to \u201cvery substantial\u201d differences between the study populations in the WHI and the observational cohorts; women in the WHI were a mean of 11 years older (63 vs 52 years), had a longer time since menopause (12 or more vs 1 to 3 years), generally had no vasomotor symptoms (compared with the presence of vasomotor symptoms), and had a higher mean body mass index (28 to 30 vs 24 to 25 kg\/m\u003Csup\u003E2\u003C\/sup\u003E).\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EEffect of Age and Time Since Menopause\u003C\/h2\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EWhen data from the two initial WHI trials were evaluated according to age group, it became apparent that the absolute rates of adverse events were much lower for younger women than for older women. For example, the E-alone trial, compared with women aged 70 to 79 years, the women who were aged 50 to 59 years had one-quarter to one-fifth of the absolute risks for CHD, stroke, venous thromboembolism, and all-cause mortality, as well as lower risks for colorectal cancer and hip fracture (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). In terms of relative risks, the E+P trial did not show a clear interaction by age (the relative risk of CHD for E+P vs placebo was 1.27 for women aged 50 to 59 years, 1.05 for women aged 60 to 69 years, and 1.44 for women aged 70 to 79 years). When the results were analyzed by time since the onset of menopause, however, it became clear that the relative risks of CHD, comparing E+P with placebo, increased with longer duration of time since menopause: RR=0.89 for women who were less than 10 years, 1.22 for women who were 10 to 19 years, and 1.71 for women 20 or more years from the onset of menopause [Manson JE et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2003].\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/5\/6\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Results from the WHI Estrogen-Alone and Health Outcomes Trial (According to Age Group).\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-700818212\u0022 data-figure-caption=\u0022Results from the WHI Estrogen-Alone and Health Outcomes Trial (According to Age Group).\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/5\/6\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/5\/6\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/5\/6\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12295\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EResults from the WHI Estrogen-Alone and Health Outcomes Trial (According to Age Group).\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ENumbers represent number of cases per 10,000 women per year. Blue=estrogen, yellow=placebo. CHD=coronary heart disease, VTE=venous thromboembolism.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from J. Manson, MD, DrPH.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EEvaluation of data in the E-alone trial showed 30% to 40% reductions in specific cardiac outcomes (myocardial infarction [MI], coronary revascularizations, and a composite of MI plus coronary revascularization) among women aged 50 to 59 years, whereas the risks of these outcomes were neutral or slightly increased in women aged 60 to 69 or 70 to 79 years [Hsia J et al. \u003Cem\u003EArch Intern Med\u003C\/em\u003E 2006]. Coronary artery calcium levels, a marker for risk of cardiovascular events, were also lower with E-alone, compared with placebo, among the younger women [Manson JE et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2007]. Pooled analysis of data from both initial WHI trials (E+P and E-alone) showed a significant trend in reduction of CHD according to time since menopause. In addition, a 30% reduction in all-cause mortality for women aged 50 to 59 years emerged, compared with increased risks for both CHD and all-cause mortality among women aged 70 to 79 years [Rossouw JR et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2007]. The absolute risks for CHD, stroke, all-cause mortality, and global index (a composite of adverse outcomes) differed significantly according to age (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). The most recent analysis of risk according to age involved a subset of WHI participants who were followed up for 10.7 years to determine the postintervention and cumulative health outcomes with E alone [LaCroix AZ et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2011]. In that study, the relative risks of CHD, MI, all-cause mortality, and the global index were significantly lower among younger women (aged 50 to 59 years) than among older women (aged 70 to 79 years).\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12297\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12297\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12297\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EAbsolute Excess Risks (Cases per 10,000 Person-Years) by Age in the Two Initial WHI Trials.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EDr. Manson said that taken together, studies indicate that very few younger women will have a substantial risk for cardiovascular or other adverse events with short-term hormone therapy. She explained that recent menopause typically corresponds to a time of early stages of atherosclerosis, when estrogen has generally favorable effects on the endothelium and plaque development. However, once advanced atherosclerosis is present, estrogen may have prothrombotic, proinflammatory, and plaque-destabilizing effects that can precipitate plaque rupture. These adverse effects of estrogen support the findings of increasing CHD risk as the time since the onset of menopause increases. Dr. Manson also noted that the observational studies that showed that decreased CHD risks are associated with hormone therapy included primarily women who were less than 5 years from menopause at the time that they initiated hormone therapy, further explaining the conflicting data between these studies and the WHI trial results.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EBreast Cancer Risk\u003C\/h2\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EThe risk of breast cancer that is associated with hormone therapy differs substantially by the type of treatment (E+P vs E-alone). With use for 4 to 5 years, E+P increased the risk of breast cancer, and the risk elevation persisted, even 3 years after treatment had stopped [Heiss G et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2008]. In contrast, E-alone reduced the risk of breast cancer; data that were collected over a follow-up of nearly 11 years showed a significantly lower cumulative breast cancer incidence that was associated with E-alone compared with placebo (26% vs 34%; HR, 0.75; 95% CI, 0.51 to 1.09) [LaCroix AZ et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2011]. Whether these findings are specific to conjugated estrogen or also apply to estradiol and other estrogen-alone formulations remains unknown. The effects of hormone therapy on breast cancer risks were consistent across age groups, thus showing a minimal modifying effect of age.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EEvidence-Based Decision-Making for Hormone Therapy\u003C\/h2\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EDr. Manson reiterated that postmenopausal hormone therapy should not be prescribed for the express purpose of preventing chronic disease. However, she added, \u201cIn a recently menopausal woman with moderate-to-severe menopausal symptoms, concern about CHD risk from hormone therapy should not be a major factor in decision-making.\u201d She presented a decision-making flowchart to help clinicians choose appropriate candidates for hormone therapy (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E). A woman\u0027s cardiac risk should also be considered before starting therapy, especially given that more favorable lipid status and low baseline risk of CHD have been associated with a reduced risk of cardiovascular events with hormone therapy [Bray PF et al. \u003Cem\u003EAm J Cardiol\u003C\/em\u003E 2008]. In some situations, transdermal estrogen may be a better choice than oral estrogen, as the transdermal formulation is less likely to be associated with increased risks of adverse events. In deciding on duration of therapy, Dr. Manson suggested treating only for menopausal symptoms and trying to discontinue treatment within 4 to 5 years; for women with persistent vasomotor symptoms, it will be important to weigh the baseline risks of breast cancer versus osteoporosis.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/5\/6\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Hormone Therapy (HT) Decision-Making Flowchart.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-700818212\u0022 data-figure-caption=\u0022Hormone Therapy (HT) Decision-Making Flowchart.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/5\/6\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/5\/6\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/5\/6\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12296\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-15\u0022 class=\u0022first-child\u0022\u003EHormone Therapy (HT) Decision-Making Flowchart.\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003ECHD=coronary heart disease, TIA=transient ischemic attack [Adapted from Manson J. \u003Cem\u003EHarrison\u0027s Principles of Internal Medicine\u003C\/em\u003E 2008]. Reproduced with permission from J. Manson, MD, DrPH.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-5\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EQuestions Remaining\u003C\/h2\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EAdditional research on hormone therapy in early menopause is needed to answer several remaining questions. Among the ongoing studies is the ELITE trial (\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00114517\u0026amp;atom=%2Fspmdc%2F11%2F5%2F6.atom\u0022\u003ENCT00114517\u003C\/a\u003E), which is designed to examine the effects of oral 17B-estradiol on the progression of subclinical atherosclerosis in healthy postmenopausal women. In addition, the KEEPS trial (\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00154180\u0026amp;atom=%2Fspmdc%2F11%2F5%2F6.atom\u0022\u003ENCT00154180\u003C\/a\u003E) involves coronary imaging to determine the effect of hormone therapy on atherosclerotic progression among younger women who are treated early after menopause, as well as an assessment of cognitive function, quality of life, and mammographic breast density. The data that emerge from these studies will arm clinicians and their patients with more information on the risks and benefits of postmenopausal hormone therapy.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/5\/6.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzn1s3\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn1s3\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzn1s3\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}