HRT ... A Dilemma For Patients and Physicians Alike
with Dr. Jane Hawes, internist with Columbia-St. Mary’s
About 6 million women in the U.S. are taking estrogen plus progestin for a variety of reasons that include symptom relief, their doctor’s advice, or for long-term health.
Ever since July 2002, however, these women and their physicians are concerned about the use of Prempro and other hormones, and they’re doing a lot of talking with each other over decisions that are best for each individual.
"I don’t believe anyone knows what the right answer is," said Dr. Jane Hawes, an internist with Columbia-St . Mary’s. It appears that some of the reasons for hormone replacement are no long valid, she added.
"Heart disease was a main reason for estrogen replacement, and we’ve known for a while that women who are taking lipid lowering drugs (to control cholesterol) are getting no additional benefit from HRT. Now it appears that women are not benefiting from HRT in terms of the prevention of coronary heart disease," Dr. Hawes said.
HRT Study Stopped
Last summer the controversial eight-year study of hormone replacement therapy (HRT) was abruptly stopped after the trial found an increased risk of breast cancer, coronary heart disease, stroke and pulmonary embolism. On the other hand, researchers also found some benefits for women taking estrogen plus progestin.
Jane Hawes, M.D.
Columbia-St. Mary’s
People need to understand that in all types of health care, they make a choice of relative benefits against risk. In this case, if they are going to be taking hormones, they should have some reason for taking them, not just because they have a prescription and have always taken them.
|
Specifically, out of 10,000 postmenopausal women who are taking HRT there will be:
• 8 more cases of invasive breast cancer
• 7 more heart attacks or other coronary events
• 8 more strokes
• 8 more cases of blood clots in the lungs
On the plus side there will be:
• 6 fewer colorectal cancers
• 5 fewer hip fractures
From a statistical standpoint, the numbers are miniscule. Some researchers and physicians even wonder if these numbers are the result of chance or the possibility that many of those who entered the study did so because they were at risk for one or more of these conditions.
The fact that the study was halted was criticized by some groups and hailed by others. There is no consensus in the medical community, at least not yet. So, what’s a patient to do, and what is a physician to recommend?
According to Dr. Hawes, the decision to begin or end HRT should depend on each individual patient. "People need to understand that in all types of health care, they make a choice of relative benefits against risk. In this case, if they are going to be taking hormones, they should have some reason for taking them, not just because they have a prescription and have always taken them."
Menopause help or not
Some women weather it easily. Others don’t. "There are certainly people whose quality of life is significantly affected by menopause. That is a perfectly valid reason to take hormones. It’s also a short-term problem and most people can get off them after a few years," Dr. Hawes said.
Though some women are reluctant to stop HRT for fear menopausal symptoms will return, stopping does not mean a woman cannot start on HRT again if she needs it. But according to Dr. Hawes, "The hot flashes and other symptoms might be a transient problem that would require only short term HRT."
Or perhaps not. "HRT is an individual choice," Dr. Hawes said. "There are women who just feel better taking hormone replacements. That’s a perfectly valid reason to continue HRT so long as a woman has thought this through and made a conscious choice."
As for bone density loss, she believes patients could use other, more effective medications to prevent osteoporosis.
Talk to your doctor
The verdict still out on HRT, all women should work with their physicians to make an educated choice on hormone use. "I don’t think anyone knows what the right answer is (concerning HRT). Doctors can only function based on what they know now," Dr. Hawes said.
If there is one thing that physicians have learned from the study, according to Dr. Hawes, it is the changeability of medicine. "Every time you think what you are reading is right and what you are telling people is right, you have to think that two or three years from now you may be telling them something else. The main thing is for a patient and her physician to always make informed choices with the best information that is currently available."
