Issue Date: March 23, 2004
Publisher: Mellanie True Hills, The Health & Productivity Revitalizer

The Healthy Living Newsletter brings you information to optimize your health, lifestyle, and work style. You are receiving this newsletter because you requested it.

This week, we focus on Hormon*e Replacement Therapy. As always, your situation is unique, so consult your physician.

HRT, or not?

Whether or not to use hormone replacement therapy (HRT) is an important concern for any woman approaching, in, and beyond, menopause. The findings revealed recently raise more doubts about the use of HRT for anything other than short-term relief of menopausal symptoms.

Until recently, doctors prescribed HRT not only for the relief of menopausal symptoms, such as hot flashes, but also for HRT's protective effect against heart disease, colon cancer, and osteoporosis. If your family history included those conditions, HRT was advised to provide protection against them, though the downside was an increase in the risk of breast cancer.

That all changed in mid-2002, when data from the Women's Health Initiative (WHI), a study sponsored by the National Institutes of Health, indicated that women using Prempro, a type of HRT combining estrogen and progestin, were at increased risk of heart disease, stroke, and blood clots. As a result, many women discontinued use of HRT, causing sales of Prempro to plummet.

Women on estrogen-only HRT—those who had had hysterectomies—were counseled to bide their time since the second part of the WHI study, on estrogen-only Premarin, was continuing. Now, however, that study has just been stopped, a year early, further challenging our beliefs about HRT. The essential question being pursued, whether estrogen-only HRT protects the heart, had been answered—the expected protective effect was not seen. Estrogen-only HRT neither increased, nor decreased, study participant's risk of heart disease, but did result in a slight increase in stroke risk. For that reason, researchers discontinued the study, moving into the follow-up stages. Quite surprisingly, no increase in breast cancer risk was seen in this study. Both studies showed a reduced risk of hip fractures, so HRT is valuable for those at greatest risk of osteoporosis.

Since estrogen-plus-progestin HRT increased heart disease risk, and estrogen-only HRT showed no difference, one likely conjecture is that estrogen's impact on our hearts is neutral, and progestin’s impact is negative, but that calls into question the belief that women have been less vulnerable prior to menopause because our bodies make estrogens. Or perhaps the difference is between the estrogens our bodies make and those from outside the body.

So what does that mean to us? If you use HRT, you should discuss these findings with your doctor and identify the potential HRT risks/benefits for you. Since many of the women in the study were in their sixties when the study began, the meaning for younger women is still unknown.

Of course, at issue now is what we should do about menopause symptoms. The FDA recommends using estrogens and progestins in the lowest possible amounts, and for the shortest possible time, so they still advise it for short-term use.

When the study started, hormone options were more limited, but there are now many non-oral forms available. Do the study's results apply just to the oral forms of hormone replacement therapy? We don't have those answers, but they're certainly worth investigating. Unfortunately, I'm out of time and space, so that will be a subject for pursuing in a future issue.

Please make a note to watch “Heart Disease: The Silent Killer” (The McCuistion Program), which features four prominent cardiologists and myself. The show will air nationally on PBS March 24-30. Check your local PBS listings for times.

I may be in your neighborhood soon, so please see my schedule of upcoming speeches.

And please share this message with friends and family that could benefit. Thanks.

Wishing you health and happiness.

Mellanie

Mellanie True Hills, The Health & Productivity Revitalizer, coaches individuals to create healthy lifestyles and works with organizations to create healthy, productive workplaces.

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