Jan looks in the mirror every morning and asks herself, “WHO AM I?”
She is 50 years old and a few months ago she started to feel out of control.
Jan has hot flashes and cannot get restful sleep due to night sweats.
She is irritable and has no patience with her family.
Her erratic moods have pushed her loved ones away.
Jan is normal and experiencing symptoms of menopause – an expected event in a woman’s lifecycle. The transition known as perimenopause often starts in the mid to late 40s with a median age of 51. There are multiple symptoms associated with menopause, but the event is different for every woman. Some women are fortunate to sail through menopause with no symptoms, but many experience a poor quality of life due to hot flashes, night sweats, mood and sleep disturbances, vaginal dryness, changes in sexual functioning, and unpleasant vaginal and urinary symptoms. If you are like Jan, you are desperate for relief, but you are concerned about the risks of hormone replacement therapy (HRT).
Are you confused about hormone replacement therapy?
Well, you should be with so many opinions out there. Who should you trust?
A friend? An article in the newspaper? Your healthcare provider? A celebrity?
“Squeeze your way to healthy hips and thighs” Suzanne Somers has given advice and published books about health, wellness, and hormone therapy over the past three decades. Do you remember the Thighmaster informercial? In the 1990s women rushed out to buy the twisty blue contraption and many were left disappointed with the same thighs. Need I say more? I am not saying that medical advice from a celebrity is wrong, but I do believe in educating patients based on sound scientific evidence. You need to know the facts about HRT. Understanding the true risks and benefits will help you feel confident in your decision to initiate, continue, or stop HRT.
The Study That Changed Everything…
In 2002, results from the Women’s Health Initiative (WHI) Postmenopausal Hormone Therapy Trial caused terror across the country. The WHI trial included three groups of women. The women were given Prempro (0.625 mg conjugated estrogen and 2.5 mg medroxyprogesterone), Premarin (0.625 mg conjugated estrogen), or a placebo. (Note: Prempro is like Premarin, but it contains progesterone, also known as a progestogen. Women with a uterus who take unopposed estrogen such as Premarin have a significantly increased risk for endometrial cancer and progesterone decreases this risk).
On July 9, 2002, the Prempro group was halted early due to an increase in breast cancer and cardiac events. Prescriptions for hormone replacement plummeted after the media publicized the findings. The headlines read “Hormone Replacement Therapy Linked to Cancer” and women were tossing their pills as if they had been poisoned. However, the results were not accurately reported and many would agree the risks associated with HRT were overblown. I will admit that I was also influenced by the media and 10 years ago I was scared to prescribe HRT due to fear of harming my patients. A few years later I decided to sit down and read the study. I was shocked by what I read…
For every 10,000 women taking Prempro each year we would expect:
*7 more heart attacks
*8 more strokes
*8 more breast cancers (in other words, 38 women taking Prempro would get breast cancer and 30 women not taking any hormones would get breast cancer)
I then thought to myself, was this study flawed? Over half of the women were over the age of 63. How many women actually take that dose of Prempro in their 60s and 70s? In addition, we know that women have an increased risk for cardiac issues as they get older. The incidence of heart disease is 12 times higher for women in their 80s compared to women in their 50s!
What the media didn’t tell you about the WHI study…
Although the Prempro group was halted early because it was perceived that health risks exceeded health benefits, the Premarin group continued. In 2004 the results were published and I think you will be shocked by these results.
For every 10,000 women taking Premarin each year we would expect:
*5 fewer heart attacks
*7 fewer invasive breast cancers
Could it be that we overreacted? Perhaps, but more research is needed and this holds true in any area of medicine. In the mean time, you need to feel confident in your decision whether or not to use HRT. As with any medication there are risks and it is recommended that you use the lowest effective dose for the shortest amount of time. Hormone replacement has been shown to decrease the risk for osteoporosis and colon cancer, but HRT should not be used to treat these conditions. Hormone replacement therapy should be used for the treatment of menopausal symptoms and treatment should be initiated with the onset of symptoms such as hot flashes and night sweats.
