Hormone Replacement: A Very Personal Issue
Many women and gynecologists have followed recent media accounts of the cancellation of a major clinical trial of the risks and benefits of the combined estrogen/progestin drug Prempro. The Women's Health Initiative (WHI) study was stopped early because of a finding of an increased risk of invasive breast cancer. The trial also found increases in the incidence of heart disease, stroke and blood clots. (An overview of the results is available at www.nhlbi.nih.gov/whi.)
The results of the WHI raise questions about managing menopause and staying healthy. Many women who have taken or are now taking hormone replacement therapy (HRT) are understandably confused and worried about present and future health risks.
At Women's Care, we believe that knowledge is power, so we encourage you to become an informed participant in your health care decisions. The decisions surrounding HRT are especially complex and individual, so it's essential to have open and frank conversations with your Women's Care physician or nurse practitioner to consider all your options.
Here are recommendations to bear in mind when considering the HRT issue:
The bottom line to this complex issue is this: If you're unclear about the risks and benefits of HRT, make an appointment for a consultation with your Women's Care physician or nurse practitioner.
Key Factors in HRT Decision-Making
The results of the WHI raise questions about managing menopause and staying healthy. Many women who have taken or are now taking hormone replacement therapy (HRT) are understandably confused and worried about present and future health risks.
At Women's Care, we believe that knowledge is power, so we encourage you to become an informed participant in your health care decisions. The decisions surrounding HRT are especially complex and individual, so it's essential to have open and frank conversations with your Women's Care physician or nurse practitioner to consider all your options.
Here are recommendations to bear in mind when considering the HRT issue:
- The WHI study involved only one formulation of HRT. The formulation, Prempro, is combined estrogen and progestin. The study's conclusions should only be applied to that formulation. Many other HRT formulations, dosages, and delivery methods—such as patches, rings and creams—are available, although it's unclear what their risks may be.
- A related WHI study of estrogen-only use by women who have had hysterectomies is continuing, and results on safety will be available after the study's completion in 2007.
- For post-menopausal women with a uterus, switching from an estrogen and progestin combination to unopposed estrogen isn't recommended because of an increased risk of cancer of the uterine lining.
- Reassessment of the need for HRT is recommended at every annual visit or more frequently if indicated.
- There are no definitive studies to guide the process for women planning to discontinue use of HRT. Whether quitting cold turkey or tapering off, some patients will develop menopausal symptoms. Women may also experience vaginal bleeding, which may at times be heavy. If symptoms recur, more gradual withdrawal may be considered.
- Management of menopausal symptoms— Women who take HRT to manage symptoms of menopause should use the lowest effective dose. Long-term use (five years or more) of continuous combined estrogen and progestin therapy should be discussed with a physician. Women who choose to continue taking HRT long-term may do so provided they have been counseled about and understand the risks. They should be encouraged to use the lowest possible dose and to consider alternatives.
- Heart disease—Based on the WHI results, combined continuous estrogen and progestin therapy isn’t recommended for prevention of heart disease.
- Osteoporosis—The WHI noted a reduction in osteoporosis-related fractures. Other preventive therapies are also available for osteoporosis.
- Colon cancer— The WHI showed a reduction in colon cancer for women on Prempro. For women with a family history of colon cancer, the risk-benefit ratio for use of estrogen and progestin may favor use of Prempro. However, these study results don't appear strong enough to recommend HRT solely for prevention of colon cancer.
- Alzheimer’s disease—The WHI study didn't address possible cognitive indications for HRT, such as prevention of Alzheimer's disease or mood disturbances.
The bottom line to this complex issue is this: If you're unclear about the risks and benefits of HRT, make an appointment for a consultation with your Women's Care physician or nurse practitioner.
Key Factors in HRT Decision-Making
- Your general health status and age
- The severity of your menopausal symptoms
- Your risk for developing chronic disorders, such as osteoporosis, Alzheimerís disease or colon cancer
- The risks and benefits of each available treatment
- Your lifestyle
- Your view of each treatment
