Should you consider hormone replacement therapy?
with Norine Nazareth, M.D., internal medicine, with Advanced Healthcare
Hot flashes, night sweats and vaginal dryness are some uncomfortable symptoms women may experience during perimenopuse, the years before menopause. Also associated with the hormonal changes that a woman's body undergoes at this time is an increased risk for heart disease and osteoporosis.
Hormone replacement therapy (HRT), a medication including estrogen often in combination with a progestin, has been commonly prescribed to help prevent these negative symptoms. This treatment aims to partially restore the hormones that naturally decrease as you enter menopause. However, a recent study researching the effects of HRT was stopped prematurely in May 2002 because of health safety concerns.
Norine Nazareth, M.D., who practices internal medicine for Advanced Healthcare, said many of her patients have questions about HRT. "It is important to determine if the menopause-related symptoms the patient is experiencing are severe enough to warrant treatment," said Nazareth. "Many women need no treatment at all, as some of these symptoms will stop on their own, without treatment, over time."
What the study found
The study, called WHI (Women's Health Initiative), was a clinical trial designed to assess the major health benefits and risks of most commonly used HRT in the United States. Participants were healthy menopausal women. It was started in 1997 and was planned to last for eight-and-a-half years.
The trial was stopped prematurely because of apparent increased risk of invasive breast cancer, as well as coronary artery disease, stroke and pulmonary embolism.
A parallel study of estrogen only (CEE) in women who have had a hysterectomy is being continued and planned to end in March 2005.
The WHI noted some benefits of estrogen and progestin, including fewer cases of hip fractures and colorectal cancers, but overall the health risks outweighed the benefits.
The study results indicated that per 10,000 women on estrogen/progestin combinations, there will be per year:
7 more coronary artery disease events
8 more breast cancers
8 more strokes
8 more pulmonary embolisms
6 fewer colorectal cancers
5 fewer hip fractures
This is still a small risk, but it demonstrates that the risk from the drug add up over time, explained Dr. Nazareth.
Confounding a widely held impression, the study found that HRT did not affect quality of life. Women taking the drugs did not feel more energetic, or have more sexual pleasure or even more restful sleep. They were not less depressed, their minds were no clearer and their memories did not appear to have improved.
"I believe that eventually each woman, as she enters menopause must work with her own physician to determine whether or not HRT is right for her," said Dr. Nazareth. "For many, the decision will be straightforward with potential for significant benefit in many areas. For others, the decision will be much more difficult, requiring a careful balance of the known benefits and potential risks."
Evaluate your risk
For women already on HRT, she said it's important to discuss with your health care provider whether stopping therapy is appropriate for you. If you and your physician determine that therapy should be stopped, tapering off therapy is advised to lessen the chance of rebound flashes.
She also advised discussing your risks for osteoporosis and heart disease with your physician. Women of childbearing age have a lower risk for heart disease than men, but after menopause the risk is the same for both genders in that age group. Also, incidence of osteoporosis increases dramatically following menopause. Doctors generally recommend a bone density test and a fasting lipid panel.
Also maintaining a healthy weight, getting adequate exercise, eating a healthy diet and not smoking all have a significant, positive impact on a woman's health as she ages.
"Building a trusting and meaningful patient/physician relationship is key to ensuring quality health care," noted Dr. Nazareth. "I encourage patients to ask questions and play an active role in making decisions about their health and ongoing care."
