Behind the Hormone Replacement Controversy
In
late May 2003, the Women's Health Memory Study
(WHIMS) released new findings regarding hormone
replacement therapy (HRT) and dementia. The
data is from
a larger Women's Health Institute study and finds that despite prior studies
suggesting that HRT may be protective against Alzheimer's Disease (AD) and
other forms of dementia, WHIMS found twice as many cases of AD occurring
in the HRT users compared to those taking placebos.
Annually,
this means that out of 10,000 women ages 65 and
older taking hormones, 45 will develop dementia
each year and 23 of those cases will be directly
attributable to hormones. It is uncertain how
this data applies to younger women currently
going through menopause. Look for more information
about HRT use in upcoming newsletters.
Behind the Hormone Replacement Therapy Controversy
Director of Penn Health for Women at the
University of Pennsylvania Health System, Ann
Honebrink, MD, Explains
In July 2002, the Women’s Health Initiative
(WHI) announced startling early findings in the
largest study of hormone replacement therapy
(HRT) ever conducted. In the past, it had been
believed that HRT provided protection against
heart attacks and offered other benefits for
menopausal women. The WHI study found that HRT
was shown to increase incidences of heart disease,
breast cancer, blood clots, and stroke.
A media frenzy followed. Facts and interpretations
churned into fear for American women. A national
poll conducted shortly after the announcement
found women “more confused than informed” by
press reports.
Ann
L. Honebrink, MD, Director of Penn Health
for Women, Assistant Clinical Professor at
the University of Pennsylvania School of Medicine
and President of the Obstetrical Society of
Philadelphia, believes that the media’s
rush to publish the first significant findings
led to unbalanced early news coverage. “There is definitely cause to re-evaluate
prescribing HRT,” Dr. Honebrink says. “However,
we have to consider other important factors.”
Almost 17,000 healthy women aged 50 to 79 participated
in a study of Prempro®, the most widely prescribed
form of hormone replacement therapy in the nation.
According to Dr. Honebrink, there are several
branches to the WHI study. The July findings
represented a five-year phase that was halted
when the results gained “statistical significance.” The
study showed that risks for breast cancer, blood
clots (thromboembolic events) and heart attacks
in women treated with Prempro® were shown
to be higher than the limits preset by the WHI.
Other phases of the study continue.
“This study is designed to evaluate the
long-term impact of HRT on a wide range of conditions
affecting menopausal women,” emphasizes
Dr. Honebrink. “This first research ‘arm’ also
indicated benefits — including a reduction
in risk of colon cancer and bone fractures.”
“In the final analysis of the WHI data,
neither risks or benefits prove to be very impressive
for any one woman,” Dr. Honebrink adds. “So
the big question is: How do we apply a huge body
of statistical data to one individual?
“It all depends on perspective,” she
continues. “We can look at the findings
in two ways: the percentage of increased risk
versus a woman’s individual increased risk
over the years of her life.”
One Example
Dr. Honebrink notes that the words “increased risk” make a better
sound bite for quick media reports. “For instance, the percent increase incidence
of breast cancer among the women taking Prempro® versus
those taking a placebo was 26 percent.”
Yet that percentage represents approximately 8 more breast cancers per 10,000
women every year in the treated group and the increase was not statistically
significant until four years into the study.
“The increased risk of breast cancer was
not seen until after more than three years of
use,” Dr. Honebrink says. “Women
in the treatment group with a family history
or other risk factors for breast cancer had the
same increase in risk as women without these
factors.
“However, women in the treatment group
who took HRT in the past seemed to have a larger
increase in breast cancer risk than those who
had never taken HRT before the study. This suggests
that the risk gets higher with more years of
treatment.”
“What Does This Mean for Me?”
“The key questions to ask yourself, and to discuss with your physician,
are: Why are you taking HRT? How long have you been using the therapy? “If
you take HRT due to menopausal symptoms, the problems might return if you stop ‘cold
turkey,’ ” Dr. Honebrink adds. “You
may want to gradually decrease your dose over
time and re-evaluate risks versus benefits. Then
see how you feel as you taper off.”
HRT virtually stands alone in relieving menopausal
symptoms. Dr. Honebrink says, “If you continually
lose sleep because of hot flashes and night sweats,
you’re at increased risk for other incidents — like
having a car accident or stressing out at work.”
Some women turn to herbal therapies but Dr.
Honebrink says the FDA doesn’t test these
supplements and the long-term effects are unknown.
In contrast, prescription drugs go through a
rigorous approval process.
She explains: “There are no drugs without side effects. If you’re
a woman who never experienced hot flashes, for example, but have been taking
HRT for heart attack or bone loss prevention, it is a good time to re-examine
your personal situation.”
The Bottom Line
Dr. Honebrink says, “Researchers are now focusing on women’s health.
The WHI trial is the first to look at preventive therapies for women, especially
on such a large scale.”
“New information comes out every day,” says
Dr. Honebrink. “We’re looking at
other treatments that may help menopausal symptoms
without increasing risk.”
“I ask my patients to remember that no
medication, supplement or vitamin replaces the
benefits of exercising, getting enough sleep,
and eating a well-balanced diet. Keep a positive
attitude, stay connected to people, and stay
in touch with your doctor. The big picture involves
your quality of life now just as much as in the
future.”
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