What Should You Do Now? Some Answers About HRT

By TARA PARKER-POPE
The Wall Street Journal
July 16, 2002

After reading countless news reports about the health risks associated with hormone-replacement therapy, a friend recently lamented that she's still confused.

"I wouldn't know what to advise my 69-year-old Mom," she says.

Indeed, a week after researchers announced that a popular form of HRT may increase risk of coronary disease, breast cancer, stroke and blood clots, many women don't know whether to switch brands, take a lower dose or quit hormones altogether. Here are answers to some commonly asked questions.

Did the study conclude that HRT is bad for you?

No. It concluded that long-term use of the most popular hormone therapy, marketed under the brand name Prempro, could be bad for you and can slightly increase your chances for several health problems, including heart attacks and stroke. This is important because for years, the conventional wisdom has been that all women should take HRT not only to deal with menopause, but also to protect against heart disease. Now doctors know that isn't true.

What does that mean for women dealing with menopause?

Many doctors likely will stop prescribing long-term HRT to women, but that doesn't mean they will stop recommending HRT use altogether. It's important to note that the health risks associated with the hormone therapy showed up only after five years, and most doctors believe short-term use is safe.

That should be enough for many women because often menopause symptoms are temporary. So for some women, that will mean using HRT occasionally or for months or even a few years. After limited use, doctors will begin to wean patients off the drugs. Some women, however, suffer debilitating symptoms for so long that doctors will still prescribe long-term therapy, believing that the quality-of-life benefits outweigh the health risks.

I'm already taking Prempro. Should I stop?

If you've been taking Prempro for a few years or more, your doctor may advise you to stop. But don't quit cold turkey or your symptoms may come back worse than before. Your doctor will phase you off the drug. If you still have symptoms, your doctor may come up with some other combination of hormones or other drugs to help you cope. Because the study looked at only one specific dose of Prempro, some doctors may advise patients to keep taking hormones, but to lower their dose or switch brands.

In deciding whether HRT is right for you, doctors will consider your individual risk for breast cancer, your risk for osteoporosis and the severity of your symptoms. For women at high risk for osteoporosis, for instance, the potential benefits of long-term HRT use on bone health may outweigh other risks.

How will this change the way women are treated for menopause?

The study will force doctors to abandon their one-size-fits-all approach to menopause and begin treating women based on their specific symptoms. For many women, that may mean no HRT at all, but diet and lifestyle changes.

For vaginal dryness, a vaginal estrogen or lubricant may be prescribed. Sometimes menopause triggers depression and mood swings, so women suffering those symptoms may be offered antidepressants or herbal remedies. For others, the hot flashes and other symptoms may be so severe that short-term use of HRT will be recommended. "Throwing out all of HRT because of this study is a hysterical reaction," says Phyllis Greenberger, chief executive of Society for Women's Health Research in Washington.

Are there other options beside HRT to battle hot flashes?

Yes. Cardiovascular drugs and antidepressants may help. Soy foods, black cohosh, flax-seed oil, vitamin E and other remedies may offer some relief for hot flashes as well as other menopausal symptoms. Christiane Northrup, an OB-GYN and author of the popular book "The Wisdom of Menopause," recommends starting with a combination of herbs, flax and soy.

Lifestyle changes, often overlooked, can make a significant difference, says Samuel L. Jacobs, associate OB-GYN professor at the Robert Wood Johnson Medical School in Camden, N.J. Cut back on animal foods and switch to vegetable foods and soy products. Weight-bearing exercise (walking or cycling rather than swimming) can improve bone health, and exercise also protects against heart disease and may relieve some menopausal symptoms. Weight-lifting can also improve bone density.

I've been taking HRT for several years. Will I get cancer or another serious health problem?

It is highly unlikely that the HRT you've been taking will cause you any health problem. Most women who suffer breast cancer, heart attacks or strokes would have them whether they take hormones or not.

However, the study did find a small increased risk among women who used hormones. The risk translates to eight more cases of breast cancer, eight more strokes, seven more heart attacks and 18 more problems with blood clots for every 10,000 women who use hormones compared with women who don't.

The risk was big enough to halt the study and change the way doctors prescribe HRT. But it is, nonetheless, still very low.