| Women Rethink Hormone Therapy in Wake of New Info |
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By Josephine Marcotty
Minneapolis-St. Paul Star Tribune
July 2002
The abrupt halt of a long-awaited study on hormone replacement therapy for postmenopausal women may seem to be the final verdict for a treatment used by millions. But the therapy is not dead, physicians and researchers said; it's just changing. On Tuesday, the National Institutes of Health said 16,000 women in a Women's Health Initiative study have been told to stop hormone replacement therapy after researchers linked it to higher risk of heart disease and breast cancer. The slightly higher health risks mean that such drugs more likely will be used temporarily to ease women through menopause, rather than for long-term prevention of chronic diseases. Thanks to the research, what has been an individual decision, based on a woman's risks and symptoms, has became a more informed one. An estimated 6 million women take an estrogen-progestin combination to restore hormone levels at menopause. Jessie Clark, 50, of Minneapolis, takes a tiny pink hormone pill every day after work, "and I'm going to take it tonight," she said. She can't take the mood swings and hot flashes, she said, and she's been losing bone density. "I'm trusting that I'm not going to be one of those statistics," she said of the health risks revealed in the study. "But I'm going to talk to the doctors and see what they say." Researchers had been studying whether the drugs not only relieve the hot flashes, night sweats and vaginal dryness that can plague women at menopause, but also improve their health in the long run. That, the investigators report, was not the case. "That's the main finding," said Dr. Karen Margolis, an internist at Hennepin County Medical Center and one of the study's authors. "This is not a long-term disease-prevention therapy." Each woman must decide what's best for her, said Margolis, who helped recruit 838 people for the study. On Tuesday morning she started the process of helping hundreds of patients do just that. The first patient Margolis talked to had started hormone replacement recently. She suffered from hot flashes and other troublesome symptoms that interfered with her life, Margolis said. Because she had no history of heart disease or breast cancer, she decided to stay on the therapy for six to 12 months, and then reconsider, Margolis said. The second patient was taking hormones to prevent osteoporosis, the result of many years of steroid treatments for asthma, and to reduce her risk of heart disease from high blood pressure. "Now we are fairly sure it won't help her heart," Margolis said. So that patient decided to stop the hormones, and take a different medication for osteoporosis, Margolis said. Doctors have known for some time that hormone replacement therapy raised the risk of breast cancer and blood clots and lowered the risk of osteoporosis. The research has been adding up for 10 years, they said, including a study published last week that concluded that the therapy did not help women with heart disease. The eight-year federal study of women between 50 and 79 was halted three years early after the researchers quantified the risks as never before. Some doctors said they fear that the public will overreact to the decision to halt the study. Dr. Andrew Good, a gynecologist at the Mayo Clinic in Rochester, said the study was halted prematurely. "To say that estrogen is the death knell is unfortunate because this study didn't tell us anything we didn't know or suspect before," he said. Another arm of the study, one focused on the effects of estrogen on women who have had hysterectomies, is continuing. That may show, he said, that progestin is the hormone that increases health risks, not estrogen. Estrogen replacement alone was proved years ago to greatly increase the risk of endometrial cancer, but Good said researchers are now looking at using lower doses of estrogen and progestin. There are other plant-based estrogens that have not been tested as thoroughly as Prempro, which is made in part with hormones from mares, but which are just as effective, he said. (Distributed by Scripps Howard News Service, www.shns.com.)
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