Hormone replacement therapy
Tonight we report on the latest development in a topic that has come to symbolize flip-flopping medical research -- hormone replacement therapy for treating menopause. A new study finds that one form of hormone therapy is not as dangerous as many people thought. Estrogen alone (Premarin is the most widely sold brand) does not increase the risk of breast cancer, according to the latest results from the huge study called the Women’s Health Initative (WHI). You can read the study itself in The Journal of the American Medical Association. You can also find more information from the National Institutes of Health and the American College of Obstetrics and Gynecology.
The reason this result appears surprising is that another form of hormone replacement therapy, estrogen combined with progestin (PremPro is the most common brand), increased the risk for breast cancer by 26 percent. That finding, announced in 2002, led to the sudden suspension of that arm of the study. It also led millions of women to abandon hormone replacement therapy, including those who were taking estrogen alone.
Part of the confusion is that many researchers, doctors and we in the media have been talking about "hormones" as though there was just one form. In fact, researchers have long known that estrogen alone can increase the risk for uterine cancer, so they only gave it to women who had undergone hysterectomies. But that is not a small number. According to the Centers for Disease Control, 25 percent of women in the U.S. have their uterus surgically removed by age 60. Women who had not undergone hysterectomies usually got the estrogen/progestin combination as hormone replacement therapy.
But to really understand the confusion over hormones, we have to go back in time. From the 1960s through the 1990s, millions of women took hormone replacement therapy for a variety of reasons. The main indication was to treat hot flashes and the other acute symptoms of menopause. But it went way beyond that. Many doctors told their patients that hormone replacement was almost a fountain of youth. Early studies indicated it might cut the risk for heart disease. Many doctors told their patients the therapy would help their skin and many parts of their body remain younger. But few of these assertions had been proven thoroughly, because hormone therapy had been on the market before the FDA had its current standards for approving new drugs.
When Dr. Bernadine Healy became the first female director of the NIH, she lobbied successfully for the WHI, a study that enrolled tens of thousands of women aged 50 to 79 to look at several key questions, among them the effects of hormone replacement. Now that the results from WHI have come in, there is a victory of science over supposition.
Hormone replacement therapy is not a fountain of youth drug. It is powerful medicine with risks and benefits. Its main benefit remains treating the acute symptoms of menopause. It also fights the bone thinning that can lead to osteoporosis. But the WHI proved that hormone replacement does nothing to help the heart, at least in this older population. It also increases the risk for strokes and blood clotting. And the estrogen/progestin combination increases the risk for breast cancer. It is not a simple picture. As Dr. Marcia Stefanick, who headed WHI, told me: "There is no question the data are confusing, and people would really like the sound bite, 'Is it good? Is it bad?'" But these results cannot be reduced to sound bites. Hormone replacement is a complex therapy that doctors should only prescribe after they and their patients appreciate the true risks and benefits.
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Hello everyone, my name is Karen and I am 47. I started menopause in my early 40s and it really hit me hard. My symptoms were endless, severe depression, weight gain. bloating, feeling my systems were not working right like my digestive functions. The weepiness…and I mean crybaby, I cried taking down the trash to the curb. My uncle a retired heart surgeon recognized the depression and told me you just don’t cry all the time. Then he wrote me a prescription for antidepressants. I weaned myself off them 6months after I started them and my primary doctors just want to write prescriptions.
I too am disgusted with the medical community and the lack of support for women’s studies on healthy alternatives. I am almost finished reading Suzanne Somers book Ageless and decided to make a commitment to myself to take my life back and take more control in my health. I will let you ladies know how my BHRT starts with my first appointment.
karen springfield pa (Sent Jan 11, 2007 6:47:32 PM)
One small detail not reported in the press was the fact that "all-cause" mortality was the same in the HRT treated group and the placebo group. This means that the numbers of deaths from any cause were statistically the same in both groups. This means that statistically a woman was no more likely to die if she was using HRT then if she didn't use HRT. She was just more likely to develop a heart attack, stroke, or cancer. Pick your poison.
Gerard Kennedy (Sent Nov 22, 2006 10:19:33 AM)
Two weeks ago today, I had a complete hysterectomy (tubes, ovaries, cervix and uterus) at 44 yrs of age - with pathology reports "benign" on all the fibroids/polops. Post surgery-went 1 week without any hormones and felt great. Then began the past 7 days of HRT with Premarin .625 mg and still don't feel any difference. Should I notice anything different? Is it important to take this very expensive Rx? Its $30 a month with my co-pay. I am searching canadian pharmacies online to save if this is something I'll have to be doing long term. But can someone answer me whether it is really necessary considering my doctor is leaving it up to me (aside from her insistence that its only estrogen and its very safe even though my mother had breast cancer so that's why I initially worried. Then was told the estrogen was good for my skin's appearance (well, we can all use help in that area so far so good). But my doctor's other concern was "you need the calcium for your bones"--yet, I've been taking a daily 500 mg calcium supplement for the past year alone and continue to eat heathly, exercise {weights, abs and walking/jogging] on a regular basis. So do I stay on this or change my mind in 30 days when I return for my post-op appt?
DW, Tuscaloosa, AL (Sent Aug 15, 2006 12:19:13 PM)
Of course there are no studies on bioidentical hormones because the drug companies would not make money. It is ALWAYS about the money. Not about what is best for women. Not to even mention all of the fake estrogens we ingest in our food, rub on our skin etc. No wonder we are sooo out of whack. Menopause is NOT a disease, but if we can think it is, Dr's and drug co's sure make a lot of money...
Read 'What your Dr. may not have told you about menopause'. Opened my eyes. Now I just have to find a doctor who REALLY is interested in healing - not about treating symptoms or pushing drugs.
Read everything on all sides of the dialog and after that do what YOU think is best.
(Sent Jul 25, 2006 8:25:28 PM)
I have been going through menapause for almost 8 years. I have severe night sweats and terrible hot flashes at least 5 to 10 times a day. I am not sleeping well (probably because of the night sweats) and my moods go up and down. I do not want to take HRT. Do you have any suggestions, herbal or otherwise?
Della Wright, Williamsport, PA (Sent Jun 27, 2006 8:51:36 AM)
Hi I am interested in taking biodentical hormones I found out about this from reading Suzanne Somers books I have been trying to lose weight with no results She claims if your hormones are in balance then with proper exercise and diet we should lose weight I want to be slim and sexy There does seem to be limited information about this. I am tring to find a directory for the doctors who can prescribe this in Ontario Canada Can anyone help with this?
Kimberly in Ontario
(Sent May 14, 2006 3:54:56 PM)
I think that the WHO & the FDA should take interest in provind/ disproving the status (good/ bad) of Bio-identical Hormone Replacement Therapy (BHRT) in the larger interest of the global population
Sachin, Mumbai (Sent May 6, 2006 3:15:21 PM)
I had a complete hysterectomy at 39. I was on HRT (primarily congegated estrogen) until I was about 50. My doctor, at that time, and every doctor I've consulted since treat me like a "drug addict" because I ask for hormones. But they have no problem writing prescriptions for addictive drugs, which I chose not to take because of that addiction risk. I can't describe the rage I've felt over this. Of course, lack of hormones doesn't do your rage any good either! I tried natural supplements with no success. I now have osteoporosis and have already lost 1/2 inch of my height. I'm 63 now, still very active and work every day. Most of the menapausal symptoms that I was experiencing have diminished slightly now but not without me losing some of my sanity and my bones. I've developed a very bad attitude towards the medical community for this and one other "standard operating procedure"...PAP tests for women with no Cervix!! I wonder how many of the doctors that insist on this test own stock in the pathology labs! Thank you for letting me vent on this subject.
Pat Jones, Horn Lake, MS (Sent May 3, 2006 4:08:22 PM)
I had to have a hysterectomy at an early age, 37, and 16 years later, I am still very confused on the use of HRT. Initially I took a low dose of Premarin (0,25)for the first couple years, but stopped after hearing all the risk involved. But now I am more confused than ever after reading that "the lack of estrogen replacement may cause women to be twice as lkely to develop atherosclerosis compared to a woman who has not undergone surgical menopause since estrogen has the ability to limit plaque formation in the arteries..the positive effects of estrogen on the vessels in the heart. The study goes on to say why estrogen, taken in early menoupause, may actually help prevent CHD, wheareas taking it years later may not. This has been the most impacting statement of all the research I have done and I need your help in clarifying this, pls. provide feedback/comments, advice, whatever!!
Cristina Lebron, New York (Sent May 3, 2006 9:33:39 AM)
I am going through menapause and I had decided that I would not be using any hormone replacement during this time of my life. After doing research on my own for some time and listening to other womens' experiences in this regard, I knew that I would "go this a la naturale" and keep watch. My experiences have not been at all like horror stories I've heard and read about. When I would have, from time to time, night sweats, I said to myself, "ah! so that's what this is?" ... and looked at this scenario objectively. From time to time, I would have, during the day time, an elevation of body heat, so I made use of a fan, which certainly came in handy! Again, looking at this in an objective manner, I was calm and it passed. Presently, I am near the "end" of this menapause period of my life. My GrandMother told me how she "got through" her time of menapause using a fan and then going about her daily duties of running a household and taking care of her children. Her no-nonsense and matter-of-fact approach spoke to me and here I am to write about it to be of encouragement to other women. Yes, women DID survive menapause before the 1960's and will continue to do so. In general, women do not have to to take hormone therapy for this normal time of their lives. Use common sense. See your physician and ask him or her if it would be alright NOT to take HRT, in light of the fact that it appears to be the logical approach, when truly it is not. See how influenced we can be by all of the numerous pharmaceutical ads promoting HRT?
(Sent Apr 19, 2006 4:53:47 PM)
I had a complete hysterectomy done at the age of 28. I have been on Premarin ever since but as a result of all of the studies done with negative results, my doctor wants to wean me off them. I am 58 years old and I feel that discontinuing the Premarin could put me more at risk because of the hormone changes.
Renee, Kitchener, Ontario Canada (Sent Apr 13, 2006 2:48:24 AM)
I am on 1 ml. per day of Natural (not Synthetic) Oestradiol Biphasic Gel applied to skin, also 1 Progesterone tab. nightly but am switching to Gel soon. After 3 years of this with higher doseage, I have had dreadful side effects like I was going to have a stroke, head bursting so can only take low doseage. I don't like troches as you cannot adjust individual doses. The benefits to me are that at my age of 66, it definitely lifts my mood and prevents melancholy also I don't feel so many aches and pains in joints. Dartnells Pharmacy Surrey Hills very good compounding pharmacy and rather than continuing to go to so called specialists, I now instruct my MD to redo my scripts for repeats. One Hormone doctor did not even warn me of side effects and said it was not her policy to warn people. Shame!
Robin Denise Kelly, Canterbury, Melbourne, Australia.
Robin Denise Kelly, Canterbury, Melbourne, Australia. (Sent Apr 12, 2006 10:30:00 PM)
I don't understand why so many women believe that Bio-Identical hormones are risk free. It's just that they are not regulated, or studied and therefore not required to disclose risk information.
Here is some information from the North American Menopause Society regarding Bio-identical Hormone Therapy. Custom-compounded hormones may provide certain benefits, such as individualized doses and mixtures of products and dosage forms that are not available commercially. However, there may be risks to the consumer. These compounds do not have government approval because individually mixed recipes have not been tested to prove that they are absorbed appropriately or provide predictable levels in blood and tissue. And there is no scientific evidence about the effects of these hormones on the body, both good and bad. Although there is a long history of pharmacies providing a wide range of compounded products, the fact that preparation methods vary from one pharmacist to another, and from one pharmacy to another, means that patients may not receive consistent amounts of medication. In addition, inactive ingredients may vary and there can be batch-to-batch differences. Reliable sterility and freedom from undesired contaminants are also concerns. Expense is also an issue, as many custom-compounded preparations are viewed as experimental drugs and are not covered by insurance plans.
Recommendations
NAMS does not recommend custom-compounded products over well-tested, government-approved products for the majority of women – and does not recommend saliva testing to determine hormone levels.
I am very happy to learn this latest news about Premarin/E alone therapy and the fact that it does not increase and may decrease the risk of breast cancer. This is great news for women. I take Premarin and I cannot tell you how much better it makes me feel. I don't wake up due to drenching sweat, or have hot flashes anymore, plus I don't care if it's proven or not but my skin appears younger and I believe it's due to the estrogen.
Good luck girls.
Mary Lark, Toledo, Ohio (Sent Apr 12, 2006 9:48:26 PM)
Please, Please, do the women of America a tremendous favor by researching and reporting on BioIdentical Hormone Therapy. The WHI only dealt with synthetic HRT. We know synthetic HRT can cause a multitude of health problems from heart attacks, breast cancer to blood clots. What is not known by the women of America is that BHRT is more effective and most importantly safe. The WHO has declared in their press release no. 167 from the IARC in August of 2005 that synthetic oral estrogens are carcinogenic.
What could be more natural and safe but simply replacing the identical hormones that are not being produced by a women's body anymore? BHRT is 'evidenced based' medicine, more so than an OB/GYN Dr, prescribing Premarin or Prempro with its 'black box' warning! With BHRT, blood levels of ALL the hormones are measured prior to and regularly monitored to assure the proper hormone levels are maintained. The past synthetic approach was take the premarin, when it doesn't work, we have some zoloft for your depression, and maybe the doctor looked at one or two hormone levels. Again I emplore you Mr. Bazelle, please do some adequate research on BHRT so you understand the safety and efficacy of this method. Once you do, I believe you will want to report on this effective safe treatment for menopause. Don't let BIG PHARMA giants like Wyeth sway your opinion. Step out of the box, and look at the obvious. One last thing, there are no long term studies for BHRT, because no one will fund one. Big pharma won't because they cannot profit. All that is available is countless testomonials as was evidenced by the number of protests to Wyeth's petition to the FDA to strictly regulate compounding pharmacies since they are taking a financial hit with the advent of BHRT. Someone like you can make a difference to help the women of America.
Terry Leder (Sent Apr 12, 2006 3:03:06 PM)
I HAVE A THEORY ABOUT DRUGS AND MEDICINES, TAKE AS LITTLE A POSSIBLE. MY DOCTOR PRESCRIBED HRT FOR ME AND I SAID NO. HE DIDN'T LIKE IT BUT, AS I TOLD HIM IT'S MY BODY AND MY POCKETBOOK THAT PAYS FOR IT. SO I'LL LISTEN TO HIM AND THEN MAKE MY DECISION. MANY TIMES WE ARE TOLD TAKE THIS PILL AND IT WILL MAKE YOU FEEL GOOD. THIS IS WHEN WE NEED TO STOP AND LISTEN TO OUR BODIES, MAYBE ALL IT NEEDS IS A REST. I HAVE LEARN THIS LESSON THE HARD WAY. WHEN I WAS IN MY LATE TWENTIES I WAS TAKING AS MANY AS 15 PILLS A DAY. I STILL FELT BAD. SO I SLOWLY STOP TAKING THE PILLS AND STARTED A MODERATE EXCERSING (WALK A MILES EVERY OTHER DAY) AND A CHANGE OF DIET(MORE FRESH VEGETABLES AND FRUITS. I NOW TAKE A VITAMIN AND NOTHING ELSE. I AM NOW IN MY EARLY SEVENTIES.
DORA W CHARLESTON WV (Sent Apr 12, 2006 2:24:30 PM)
Take it a step further...most studies are of the use of conjugated estrogens from horse urine or a synthesized form. They are not biologically identical. There is no study that I am aware of that looks at long term use of bio - identical hormones which may reduce side effects and risks further.
Tim Patterson, Twin Cites, Minnesota (Sent Apr 11, 2006 7:51:29 PM)
Please research the beginnings of HRT. Before the 1960's, women were handling the effects of Menopause the natural way, as it should be. Once the pharmaceutical company's realized the potential of their market, the doctors who prescribed HRT benefited monetarialy; and thus, the beginning of increased health risks for women due to untested HRT. Please inform the public the ingredients in HRT and how they are obtained. My mother died at age 42 from a heart attack, I was aware of the health risk of HRT and refused to take synthetic hormones. I researched on my own, changed doctors and have reached menopause, feeling wonderful, using natural methods. Asian women have sucessfully handled this approach for years. I exercise, eat healthy, and take NATURAL supplements. The FDA has proven to the American public they are not equipped to handle today's health issues, especially when they are subsidized by pharmaceautical companies. The best way to report this issue is to implore women to fully research all their options the natural way before even considering any form of pharmaceutical entering their body. I am an example of listening to my body and doing the absolute purest way of entering into a wonderful time of my life!
Nancy Holt, Tampa, Florida (Sent Apr 11, 2006 7:19:26 PM)
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