Health
HRT Help
ThirdAge Women's Health Expert
Hormone replacement therapy (HRT) has suffered a highly publicized setback. The Women's Health Initiative study, which evaluated combined estrogen and progestin use in postmenopausal women, was halted after the study's safety monitoring board concluded that the risks of combined HRT use outweighed its benefits.
Specifically, the study reported that a comparison of 10,000 women taking the hormones with 10,000 women not taking the hormones found eight more women with invasive breast cancer in the hormone group. Additionally, seven more women in the HRT group had heart attacks, eight more had strokes and eight more developed blood clots in their lungs.
The benefits were that in the hormone group, there were six fewer cases of colorectal cancers and five fewer hip fractures. Clearly, the risks outweighed the benefits.
So, what should the estimated six million American women who are taking HRT do now? Considering that a significant risk was observed after an average of 5.2 years of hormone use, short-term use to treat hot flashes and night sweats may still be appropriate.
In a press release by Wyeth, the manufacturer of the combined HRT used in the study, Victoria Kusiak, M.D., vice president of clinical affairs, stated that even though the study's findings were significant, we need to recognize "the critical role combination HRT plays [in treating the symptoms of menopause] for healthy women beginning therapy in early menopause."
Her sentiments were echoed in a statement by the American College of Obstetricians and Gynecologists (ACOG): "Hormone replacement therapy for the treatment of acute menopausal symptoms, when indicated, continues to be appropriate for short-term use without an apparent increase in risk of breast cancer for up to four years."
Jacques Rossouw, M.D., one of the authors of the study, commented that in women already taking combination HRT for short-term relief of menopausal symptoms, "the benefits are likely to outweigh the risks."
Thus, the consensus seems to be that if you are already on HRT or are suffering from hot flashes and night sweats, short-term (four years or less) use of HRT seems safe and effective.
If you have been taking HRT for more than four years for the symptoms of menopause, your doctor will probably recommend an alternative treatment. Treatments can include antidepressant drugs, herbs such as black cohosh, soy foods or high-dose vitamins.
ACOG also recommends:
1. Women at risk for heart disease who choose to discontinue use of combined estrogen and progestin therapy should explore alternative therapies to hormone replacement, including the use of (cholesterol-lowering) drugs and lifestyle modifications such as regular exercise and smoking cessation.
2. Women at risk for osteoporosis who choose to discontinue use of combined estrogen and progestin therapy should explore alternative therapies such as Fosamax (alendronate).
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