Debunking Long-Held Menopause Beliefs

Sally Shumaker, PhD, professor of social sciences and health policy, has spent the better part of two decades leading the charge to study older women’s health issues and, in particular, the safety and efficacy of hormone replacement therapy.

She understands the history, the marketing and the early studies that led to the belief in hormone replacement therapy was a solution to hot flashes and night sweats suffered by women during menopause and after, and as a possible protector against breast cancer, heart disease and cognitive function.

She knows that for many years, hormone therapy was “like a fountain-of-youth thing. It wasn’t a hard sell from a marketing perspective.”

Shumaker joined the School of Medicine in 1990 after six years at the National Institutes of Health (NIH) as a behavioral scientist. She has been at the center of the national research effort called the Women’s Health Initiative (WHI), a cluster of NIH studies and randomized clinical trials.

The clinical trials tested the effects of hormone replacement therapy in post-menopausal women on heart disease, breast and other cancers, and cognition and dementia. The investigators found that hormone therapy could be more harmful than helpful.

WFBMC Takes Part in National Study

Although Wake Forest Baptist had already been selected as a participant in the research effort, Shumaker wound up being chosen to lead the study of cognitive function in women taking hormone replacement therapy. The protocols established by Shumaker and her colleagues for the Women’s Health Initiative Memory Study (WHIMS) on how to conduct valid cognitive assessments set an industry standard and are used today by hundreds of other scientists in all types of research across the U.S.

“Because of our ability to demonstrate that scientists could efficiently and effectively conduct a large study on cognition nationally, we’ve launched a number of studies on cognition, and WHIMS was sort of the mother ship on this,” she said. “I think this was major for Wake Forest and for public health sciences.”

Shumaker wound up becoming the first director of Wake Forest Baptist’s Women’s Health Center of Excellence for Research, Leadership, Education. She said she knows that the clinical trials disproving the effectiveness of hormone replacement therapy for many outcomes other than hot flushes and night sweats was not necessarily what women or physicians wanted to hear.

But she also said she knows that the results led to the FDA changing the labeling on post-menopausal hormone replacement therapy to note the potential harm for older women.

The Future of the Therapy

Questions continue regarding the potential benefits of the therapy, and some physicians still support its use beyond relief of symptoms associated with menopause. It is clear that hormone replacement therapy is effective in treating menopausal symptoms. The current recommendation for women, however, is to take the lowest dose for the shortest period of time, a clear result of the research conducted by Shumaker, her colleagues and Wake Forest Baptist.

“My own personal recommendation is I wouldn’t touch it with a 10-foot pole unless I was so miserable during menopause that that was the only thing that could help me get through it,” Shumaker said of hormone replacement therapy.