Examining Alternatives to Hormone Replacement Therapy
by Carol Berres
For many years, menopausal women have weighed the obvious benefits of hormone replacement therapy (HRT) against the known risks. But in July of 2002, the National Heart, Lung, and Blood Institute announced it was stopping a major clinical study on HRT, concluding that, for some women, the risks outweigh the benefits.
The study, part of the Women's Health Initiative (WHI), found small but significant increases in breast cancer, cardiovascular disease, stroke and blood clots in study participants who were taking estrogen plus progestin, compared to women taking a placebo. (The study also found fewer cases of hip fractures and colon cancer in the nonplacebo group.)
The WHI study does not rule out traditional HRT as the right choice for some women but it has raised some questions. The American College of Obstetricians and Gynecologists has issued these recommendations:
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Herbal formulations may help menopausal symptoms but not offer protection against bone disease or colorectal cancer. I would advise patients to know what you want to get out of any chosen treatment regime.
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"Since the percentage of women in the WHI study who actually had adverse effects from HRT use was small, the size of the risk for each individual woman on HRT was also small...The bottom line is that while HRT is still an acceptable option for the treatment of menopausal symptoms in certain cases, the decision for a woman considering whether to use HRT and for how long has become much more complex."
This development is sure to fuel the trend already in motion for women investigating complementary or alternative treatments for menopause. A 1997 study conducted by the North America Menopause Society found that more than 30 percent of women use acupuncture, herbal supplements or plant estrogens (phytoestrogens). Just five years later, the Center for Health Studies Group Health Cooperative in Washington state published a study of 886 women in which more than 76 percent used at least one of eight different alternative therapies for menopause symptoms.
Scientific proof still lacking
The National Center for Complementary and Alternative Medicine (NCAM) states, "At this time there is not enough scientific evidence to determine whether these therapies are beneficial... In addition, we do not have sufficient information to show whether these therapies are as safe or safer than conventional drugs being used for menopausal symptoms, osteoporosis or heart disease." Nevertheless, more than 89 percent of the women in the Washington study found them to be somewhat or very helpful.
Patricia Dolhun, board-certified physician of obstetrics and gynecology with Columbia St. Mary's, has noted an increase in patients concerned about HRT since the WHI study announcement. More of her patients are asking about alternative or complementary therapies, such as soy and soy-derived products and herbal supplements. When investigating complementary therapies, patients should be aware of limitations, says Dolhun.
"Herbal formulations may help menopausal symptoms but not offer protection against bone disease or colorectal cancer. I would advise patients to know what you want to get out of any chosen treatment regime," she says.
It's also important for women to consider how drugs and herbs may interact, adds Dolhun. By the time most women reach menopause, they are at an age where they may be taking medications for other health problems.
"People should not look at alternative therapies as risk-free," says Dolhun.
