Healthy Hormones

Patients Weigh Quitting Drug After Research Indicates Risk

By MARY DUENWALD – July 10, 2002

The news that thousands of women in a national study were suddenly being taken off hormone replacement therapy ushered in a day of reckoning for the millions of other women who take hormones. They all had the same simple but vexing question: Should I quit, too?

As their doctors scrambled for answers, a consensus of sorts seemed to emerge, in which hormone users were divided into two categories: women who had taken them only a year or two to treat hot flashes and other temporary symptoms of menopause and those who had taken them for years.

In the short-term, doctors said, hormone replacement therapy still seems safe. But it does not look as promising as it once did for a woman’s long-term health.

“If a woman has only been taking hormones for a year or two to treat hot flashes,” said Dr. Lori Mosca, director of preventive cardiology at New York Presbyterian Hospital, “it’s probably safe for her to go on. But if she’s been on hormones for 10 years, it’s time to stop.”

For many women, the choice to quit or continue hormone therapy will not be easy.
Some said yesterday that increased risk of breast cancer, heart disease and blood clots found in the study did not seem great enough to warrant going off hormones.
“I’ve read the reports,” said Rosemary Herpel, 59, of Shaker Heights, Ohio. “We’re talking about 8 more people in 10,000 who got breast cancer. I just think that’s not significant enough to make me stop. I’m very concerned with bone loss. I have friends who haven’t taken hormones, and they are experiencing bone loss.”

Janice Kennedy, 56, a third-grade teacher in Lima, Ohio, said: “I’m really not buying what they’re selling. I know their studies have documented numbers, but for me, hormone replacement has been beneficial.”

Ms. Kennedy sees her doctor once a year and has regular mammograms and pap tests. Because she is on a low-dose estrogen patch, and progestin in pill form, and there is no breast cancer in her family, she feels safe.

Many women who take hormone supplements to treat temporary symptoms of menopause may decide to continue, said Roger A. Lobo, professor of obstetrics and gynecology at Columbia-Presbyterian Medical Center in New York.

“If a woman wants to take estrogen and progestin for her quality of life, my recommendation would be that she take the hormones in low doses and that we monitor those doses once or twice a year,” Dr. Lobo said. “And she should have mammograms once a year.”

Hot flashes, which are caused by fluctuations in natural hormones, typically last only a couple of years, as women go through menopause, doctors say.

Dr. Lobo said he commonly prescribed hormone replacement therapy in doses that were only half as large as those used in the Women’s Health Initiative study.

One patient, Dr. Lobo said, is determined to remain on hormone replacement therapy in spite of being at some risk for breast cancer. “We’ve tried to take her off before,” he said, “but she has such bad hot flashes, she can’t sleep, and it affects her work.”

But the study did not specifically address whether women at high risk for breast cancer are any more likely to get breast cancer when they take the hormones. Doctors will be less likely to recommend hormone replacement therapy for women looking to prevent heart disease and preserve their long-term health.

“We have to stop using the drugs for healthy women,” concluded Dr. Maura Parker Quinlan, a hormone replacement therapy specialist at the University of Chicago Hospitals, who is now recommending that her patients stop taking estrogen and progestin. “The risks of breast cancer, stroke, heart attack and blood clots outweigh the benefit for bones. And we have other drugs we can use to prevent osteoporosis.”
Deborah Bublitz, 69, a pediatrician in Littleton, Colo., said she would go off the hormones immediately, “but I just hate to think about suddenly getting menopausal symptoms.”

Dr. Bublitz started hormone replacement therapy 11 years ago. She appreciated the relief from hot flashes, night sweats, frequent urination and mood swings.
“When I started hormone therapy, I felt like I was riding in a car that suddenly got shock absorbers,” Dr. Bublitz said. “I stopped reacting to little things as if they were big things. My energy was better. I could remember people’s names again, or where I put this or that.”

But the new findings make her worry that supplemental hormones could be bad for her cardiovascular health. “I still work 12-hour days,” Dr. Bublitz said, “and the thing I would worry most about would be a stroke or a heart attack that would leave me handicapped for many years.”

Copyright 2002 The New York Times Company

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