ASK THE DOCTOR: Hormone replacement causes more harm than good
By DR. JIM MITTERANDO

The recent, highly publicized findings that hormone replacement causes more harm than good have created concern and confusion for both women and health care providers.

The Women's Health Initiative Hormone Replacement Trial was the first big study to evaluate whether long term use of Prempro (a combination of estrogen and progesterone) may prevent complications such as heart attacks or osteoporosis. The eight-year study was stopped after only five years because the risks (albeit small) outweighed the minimal benefits. The study is still ongoing for women with hysterectomies taking the drug Premarin, an estrogen-only replacement pill. These results are due in 2005 to see whether long-term estrogen, alone, is beneficial

Women have fewer heart attacks than men but quickly catch up after menopause. It was thought that estrogen may prevent heart attacks and potentially slow some of the aging process. Smaller studies in the past suggested that hormones were beneficial despite the small increased risks of blood clots and breast cancer. I was one of those believers until this recent study.

This new research shows that the combination of estrogen (Premarin) and progesterone (Provera) therapy had minimal benefits and increased the risk of heart attacks, as well as, mildly increased the risk of breast cancer, strokes and blood clots. As a result, the study concluded that Prempro should not be used for preventative purposes.

According to the research over five years: Estrogen therapy reduced the risk of hip fractures from 0.75 percent to 0.5 percent and reduced colon cancer from 0.8 percent to 0.5 percent. However, during this same time period a woman's risk of heart attack was increased from 1.15 percent to 1.5 percent. The risk of breast cancer was increased from 1.5 percent to 1.9 percent and risk of blood clot was increased from 0.65 percent to 1.3 percent.

These increased risks are small - affecting fewer than 1 in 1,000 women per year. Many medications have greater risks, but are considered tolerable because they have greater benefits.

The whole purpose of healthy women taking long-term hormone therapy was to preserve health and prevent disease. Estrogen/progesterone therapy does not have much long-term benefit so that its small risks do not justify long-term use. It is not the "fountain of youth" that had been hoped for.

It is important to realize that estrogen is still a very useful medication to help treat hot flashes, mood swings, loss of libido and vaginal dryness during the first several years of menopause. In this instance, the benefits are greater. Women can weigh these benefits against the risks mentioned above and decide whether to continue. Treatment of menopausal symptoms with estrogen should now only last for several years - at which point, alternative treatments can be discussed with your health care provider.

The results of the Women's Health Initiative Study are only applicable to the drug Prempro (Premarin and Provera combined) . But the burden of proof now rests on the companies that make other estrogens, progesterones or herbal medications to prove that long-term use of their product is safe and beneficial.

If you have questions or concerns, make an appointment with your health care provider to discuss these further. If you are taking Prempro for more than several years discuss whether you should wean off this medication.

Don't worry if you continue to require hormonal treatment to control menopausal symptoms. In this case, you are deriving benefits from this medication that may outweigh the small risks mentioned above. To further decrease your risk, you could decrease or change the type of estrogen or progesterone therapies you use.