IS HORMONE THERAPY FOR YOU?
Ladies from the 1970’s terrified generations to come about the use of HRT but the door may be opening again for menopausal women suffering from hot flashes and night sweats. Relief may be at hand but is hormone therapy for you?
Hormone replacement therapy to treat symptoms of menopause does not increase a woman’s risk of early death — either overall or specifically from cancer or heart disease, according to long-term findings from the largest clinical trial conducted on hormone therapy.
NO INCREASED RISK
Women who took estrogen for an average of seven years or combination estrogen and progesterone therapy for an average of five years had no increased risk of death after 18 years of follow-up, compared with women given an inactive placebo, the researchers found.
The clinical trial “provides support for the use of hormone therapy for treatment of bothersome and distressing hot flashes, night sweats and other menopausal symptoms that may impair quality of life in women who don’t have a reason not to take hormone therapy,” said lead author Dr. JoAnn Manson. She is chief of preventive medicine at Brigham and Women’s Hospital in Boston.
These latest results from the Women’s Health Initiative (WHI) trials shed more nuanced light on findings published in 2002 from the same study, said Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society.
The 2002 report found that hormone replacement therapy increased women’s risk of breast cancer and stroke, Lichtenfeld said. After that, many doctors became reluctant to prescribe hormone therapy for menopause symptoms.
The new update shows that women are not more likely to die after using hormone replacement therapy, even if the therapy increases their risk of health problems such as breast cancer, stroke and heart disease, Lichtenfeld said.
“There is a risk of adverse events, but those adverse events don’t lead to premature death,” Lichtenfeld said.
Women now must decide whether they wish to take the risks of nonfatal events by using hormonal therapy, with the understanding that it doesn’t appear to change overall life span, Lichtenfeld added.
Menopause is defined as a woman’s last menstrual period, occurring at an average age of 51, according to the North American Menopause Society. This natural life event leads to lower levels of estrogen and other hormones, which can cause discomfort for some women.
Estrogen alone can be prescribed to women who have had a hysterectomy, Manson said. For others, progesterone is also given to protect against increased risk of cancer of the uterus from estrogen therapy.
The WHI trial tracked more than 27,000 women, average age 63, who received either hormone replacement therapy or a placebo between 1993 and 1998.
After 18 years — including 10 to 12 years of follow-up after women ceased hormone therapy — researchers behind the new review found no positive or negative effect on death rate linked to treatment with either estrogen, or estrogen plus progesterone.
Manson said the lack of impact on death rate from any cause is more important than the findings associated with death rate from cancer or heart disease.
“When you’re testing a medication that has a complex pattern of benefits and risks, all-cause or total mortality is the ultimate bottom line when assessing the net effect of a medication on serious or life-threatening outcomes,” Manson said.
Cancer-related deaths linked to combination estrogen/progesterone therapy appeared to be a wash, as the treatment increased risk of breast cancer but decreased the risk of uterine cancer, Manson said.
“We found that hormone therapy really didn’t affect most other types of cancer, so the overall effect of hormones on cancer deaths was neutral,” Manson said.
Lichtenfeld brought up another point: Women on hormone therapy may not be more likely to die from cancer or heart disease because doctors have gotten better at treating those diseases, he said.
“It’s reasonable to consider that better treatments have improved the outlook for these illnesses,” he said.
Lichtenfeld also emphasized that the hormone replacement given to the women was temporary in this trial.
“This study does not mean that a woman can nonchalantly start hormone therapy and stay on it for the rest of her life,” he said. Study participants received “a modest term of hormonal therapy to deal with the immediate symptoms” of menopause, Lichtenfeld explained.
Manson added that the study only included estrogen and progesterone in pill form, since that was the only formulation available at the time. Women now have access to hormone therapy that is absorbed through the skin via patch, gel or spray, plus the ability to receive lower doses than were used in the WHI trial.
“We need more research on the benefits and risks of some of these newer formulations,” Manson said.
The trial results were published in the Sept. 12 issue of the Journal of the American Medical Association.
A SENSITIVE TOPIC
We find that people are either very for or very against the use of hormones, so where does your opinion fall (please feel free to comment here on the blog)
My feelings are that like medication, it is only as good as the doctor prescribing it and the monitoring performed. I agree totally that you cannot just take a medication and stay on it indefinitely without adjustment. I also feel that we have come a long long way since the HRT of the 1970’s. The hormones prescribed were of a standard does and of equine source – right there every woman sees a problem, first we are not horses (duh) and second, our hormones are not released in a uniform way throughout the month so how can they be prescribed in a standardized does, the same amount for every woman?
The body is too smart for synthetic hormones. The term “bioidentical” is crucial here as a hormone has to be identical to be recognized by its receptor. Imagine having a key which was similar to the one needed to unlock a lock. There is a good chance that similar key is going to get stuck in the lock and cause problems – same with a synthetic hormone.
To compare the HRT of the 70’s with the bioidentical hormones of today would be a huge mistake.
I have seen a number of ladies in my office incredibly upset with the emotions and weight gain they have suffered since being prescribed estrogen and estrogen alone. It might be a cream or that estrogen patch but it resulted in a 5-15lb weight gain – all in the midsection, I am not a doctor and I am not going to suggest I am even an authority of the subject, but I am a woman who has experienced and has read enough to know that estrogen therapy alone makes no sense.
Women produce both estrogen and progesterone, it is a very fine balance. Both hormones decline with age although progesterone declines at a faster rate. ironically leaving us with estrogen dominance. If estrogen and progesterone are declining together but progesterone drops faster the difference between the 2 hormones increases (see chart) so even though both hormones are declining, estrogen becomes “dominant”
Premenopausal women (that would be me) recognize this with mood changes (pessimism, worry), sleep issues, water retention, and weight gain.
So, we are premenopausal (estrogen is declining yet dominant) and then we slap on an estrogen patch, making the situation even worse! A lot of the women I work with are diligent with their nutrition and training, so when they gain 10lb for no apparent reason it is incredibly upsetting.
Estrogen also promotes cell proliferation (hence its link to cancer) so to use it alone would seem unwise. It seems pretty obvious that as women we need to preserve the balance of estrogen and progesterone as long as we can and this means regularly checking our blood work at the right time of the month. Little can be understood if you do blood work at the beginning of a cycle when progesterone is non existent and estrogen is low.
Men are pretty simple creatures (had to say it :)) and their testosterone levels can be checked anytime to get an accurate reading but we women are more complex, we have lived the ups and downs of our hormones since being teenagers and we know no two days are the same. To understate the importance of our hormonal cycle would be another mistake
PERSONAL DECISION – is hormone therapy for you?
HRT is a very personal decision but I suggest you not base that decision on the experiences of your mother or elderly aunt. Is it a coincidence that most diseases and illnesses start to occur when our hormones start to decline? Hormones and especially hormonal balance is our protective shield. Too much or too little of any hormone can create a diseased state and this is the point I felt I needed to make in this blog post.
The most important decision you make when it comes to HRT is the doctor you chose to work with. If a doctor does not advise you when to do your lab work or if a doctor suggests estrogen therapy only it may be a red flag.
Personally, I am lucky enough to work with Dr Howard Elkin at the Heartwise institute in CA – be sure to sign up to his blog at www.Heartwise.com/blog/
Hope you enjoyed this post, be sure to subscribe and leave comments or questions