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Local doctors on hormone study

Don't be alarmed

Don't be alarmed

July 22, 2002|by GINNY FITE & KATE COLEMAN

Local ob-gyns David H. Solberg and Eva A. Olah have been inundated with calls since researchers published the news from the Women's Health Initiative study two weeks ago.

Researchers stopped the clinical trial involving 16,000 healthy women three years early due to findings that the women taking a combination estrogen and progestin hormone replacement pill were at increased risk for heart attack, stroke, breast cancer and blood clots.

The numbers released by the study are staggering - a 29 percent increased risk of nonfatal heart attack; a 41 percent increased risk of stroke; a 26 percent increased risk of breast cancer; and a 100 percent increased risk of blood clots in the lungs and legs - and women want to know how those numbers apply to them.

"The percentages are more alarming than the actual risks to an individual," says Solberg.

To understand how this information affects you, you need to look beneath the surface of the data, Solberg says.

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Olah also is advising her patients not to be alarmed. She points to a release from The American College of Obstetricians and Gynecologists that looks at what's called the "absolute numbers" instead of the percentages.

"This WHI population study group," the release says, "was 16,608 healthy women ages 50 to 79. The data indicate that if 10,000 women take the hormone combination for one year,

-- 8 more will develop invasive breast cancer;

-- 7 more will have a heart attack or other coronary event;

-- 8 more will have a stroke; and

-- 8 more will have blood clots in the lungs.

However, (the good news is) among women receiving combination hormone therapy, as compared to the placebo group,

6 fewer will have colorectal cancers, and

5 fewer will have hip fractures."

So the question is, will you be one of those women who has the stroke or heart attack or gets breast cancer? And how do you assess your own risk?

"If you look at how long you live, whether you take hormones or not, or if the cause of death is different, the answer is no," Solberg explains. "The length of life is the same, the cause of death is the same" whether you take the hormones or not.

Olah says that if you are not at increased risk for heart disease or breast cancer and you're having difficulty with menopause symptoms, then you might want to take hormone replacement. It's an individual decision made in consultation with your physician, she says.

"The timeline has changed," Olah says. If you're experiencing hot flashes, night sweats, insomnia, memory loss, difficulty focusing and concentrating, and loss of desire, you might consider hormone replacement therapy for a short time - four years.

Olah's recommendations would also be different for a 47-year-old woman and a 79-year-old woman.

In addition, other hormone therapies were not tested in this WHI study, Solberg says. Only Prempro, made of conjugated equine estrogen from pregnant mares' urine and medroxyprogesterone acetate (a synthetic progesterone), was used in the study.

The WHI study is the third to conclude that hormone replacement therapy is not good for all women and very bad for some.

The HERS study (The Heart and Estrogen-Progestin Replacement Study) published in 1998, designed specifically to look at heart disease in women taking estrogen, saw increased risk of heart disease in the first two years. The drug did improve cholesterol levels later.

Doctors are no longer prescribing this hormone replacement therapy for the prevention of heart disease, Olah says.

The Nurses Health Study in 1995 said women taking estrogen alone had a 36 percent increase in their risk of breast cancer; those taking estrogen plus progestin had a 50 percent increase in risk; those taking the combination for five to 10 years had a 46 percent increase in risk.

They also live one year longer, Solberg says.

If you are already on Prempro and want to stop, Solberg says, just stop. There are no studies, he says, that show that you need to taper off.

Olah says women should gradually go off the drugs. She has no research to prove her position, but she senses that is the right approach.

Women who want to use alternative approaches to treating menopause symptoms should also talk with their health care providers, the doctors say.

Herbals are not regulated by the FDA, and dosages cannot be guaranteed, Solberg says. The quality of each preparation can be different, Olah cautions.

"I am 100 percent convinced of the potential value of herbal products but I don't think the industry is regulated enough unless (women) get a prescription from an herbologist," Solberg says. He does refer patients who are interested in alternatives to the Center for Traditional Oriental Medicine in Hagerstown.

There are also other FDA-approved treatments for prevention of osteoporosis after menopause rather than estrogen, such as Fosamax or Evista.

Vitamin E, says Solberg, is also good for the heart and calcium is good for the bones, but basically "exercise, eating right and taking good care of your body is best. Sometimes we try to get health though a bottle, when the road to health is through our own hearts and souls."

Bottom line: trust your intuition. It's an individual decision. If you're taking hormones and feel good, do it. And take a look at your situation every year. If you're uncomfortable, don't do it.

- ginnyf@herald-mail.com; katec@herald-mail.com

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