Should Anyone
Take Hormones?
By: Sanjay Gupta
Time magazine, July 8, 2002
A new study raises disturbing questions about the safety
of hormone-replacement therapy
Hormone-replacement therapy (HRT), which for years was offered to
postmenopausal women as a remedy for nearly everything that ailed them,
from hot flashes to heart disease, took another hit last week. The Journal
of the American Medical Association published the outcome of a seven-year
follow-up study that doctors hoped would show, despite disappointing
results the first time, that long-term hormone replacement does in fact
protect women against heart disease. Instead, the study showed the
opposite. Not only did HRT fail to reduce the risk of heart attacks and
strokes, it significantly increased the incidence of blood clots and
gallbladder disease.
Coming on top of studies linking HRT to increased
risk of breast and uterine cancers, the study might well lead the 17
million American women who are taking hormone-replacement therapy to
wonder whether they are making a big mistake. Given all the bad news, are
there any good reasons to take hormones?
It's a fair question, but to answer it you first have
to understand that women take hormones for a wide variety of reasons. The
new study focused on elderly women (average age: 67) who already had signs
of heart disease and were hoping HRT would help ward off further trouble.
Dr. Diana Petitti, who wrote the journal's accompanying editorial, is
pretty clear about what the study means for this group of women.
"Don't start, and do stop," is how she puts it. "HRT just
doesn't offer any protection."
But that doesn't mean HRT is worthless for all women.
Even Petitti acknowledges that HRT has a role to play in treating what she
calls "the acute symptoms of menopause"--which is what the vast
majority of women who take it are using it for. These symptoms include hot
flashes, mood swings, sleep difficulties and vaginal dryness. If you are a
woman who is having difficulties with the onset of menopause and find that
HRT relieves your symptoms, there is no reason to stop, at least for now.
But after the symptoms subside, usually within a year or two, ask your
doctor whether you need to continue hormone therapy; more physicians are
starting to view HRT as a short-term rather than a long-range treatment.
Hormone therapy was also believed to prevent
fractures due to osteoporosis, but the new study raises questions about
that too. Women in the trial who were on hormones had a slightly higher
rate of hip fractures than those taking a placebo — the opposite of what
was expected. For the definitive answer on this and other unresolved
questions, doctors are awaiting the results of the big Women's Health
Initiative study of HRT, due out in 2005.
The good news is, other treatments work quite well in
combatting heart disease and osteoporosis. Several studies have shown the
benefits of aspirin, beta-blockers and, for women at particularly high
risk, ace inhibitors to prevent blot clots and reduce high blood pressure.
For women with a history of low bone density, biphosphonates (which reduce
bone destruction) and raloxifene (Evista) can help ward off fractures.
The best prevention for many postmenopause effects is
to stick to the basics before menopause: eat right, drink milk, get plenty
of exercise and have your cholesterol and blood pressure regularly
checked.
Dr. Gupta is a neurosurgeon and CNN medical
correspondent
FAIR USE NOTICE: This
page contains copyrighted material the use of which has not been
specifically authorized by the copyright owner. Global Action on Aging
distributes this material without profit to those who have expressed a
prior interest in receiving the included information for research and
educational purposes. We believe this constitutes a fair use of any such
copyrighted material as provided for in 17 U.S.C § 107. If you wish to
use copyrighted material from this site for purposes of your own that go
beyond fair use, you must obtain permission from the copyright owner.
|
