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Subscribe to RSSYears ago I asked Dr. Elizabeth Barrett-Connor, one of the leading experts on hormone replacement and a professor of epidemiology at the University of California, San Diego, for her help in reporting on the issues surrounding hormone replacement therapy.
"I think it's been a very trying time for the practitioner," she said. "I think we're at a very elementary stage of how to prescribe hormones."
I pointed out that some patients wonder how, 60 years into the game, the science of the hormone estrogen can still be at an elementary stage.
"Yes. It is interesting. But I ... do think we've made a lot of progress."
With a good deal of encouragement from drug companies, but little substantive evidence, millions of women came to see hormone replacement as a "cure" for the "disease" of aging. We now know that was fanciful.
There is no question that hormone replacement effectively treats hot flashes, mood swings and other symptoms of menopause. It also lessens the bone thinning of osteoporosis. But no one knows if it cuts the number of hip fractures, the biggest danger of osteoporosis. While doctors once thought hormone replacement reduced the risk of heart disease, the Women's Health Initiative (WHI), a placebo-controlled trial of 16,000 women--a sort of gold standard of medicine--found that it did not. Most importantly, in 2002 the WHI was halted because of the increased incidence of breast cancer in women taking the most common hormone replacement, estrogen and progestin, sold as PremPro. New results out today show that the cancer associated with that increased risk are more dangerous than many doctors had assumed.
The results show the importance of controlled clinical trials and the need to not rely on more casual observational studies before millions of people take a medication. There are countless questions about hormone replacement still to be answered
This is the new era of medicine where both patients and doctors know there is no right answer and today's answer might be different tomorrow. "I think both the doctor and the woman need to realize that every woman is different, Barrett-Connor said. "This isn't a cookie-cutter business."
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Mr. Bazall: An enlightening Blogg and I agree with you that every woman is different and doctors
are not of one opinion, so both hve to work together and a patient should do her homework.
Phyllis Kunz
I have a question about the hormone replacement trial. Was the hormones used in the trial, bioidentical hormones or hormones from horse urine.
Thanks
Charlene
In the newscast, PremPro was shown and I do believe that is what the report is referring to. For your own information, you could read the full JAMA (Journal of the American Medical Assoc) report. The manufactured combination hormones, estrogen and progesterone, are what is known, in combination, to cause breast cancer. I am a 12 year survivor and this was known in 2002 (3 yrs after my diagnosis) when the nurse's study was stopped abruptly. See the article dated then from TIME magazine. A dr. in Washington state also suspected as much long before that came out. I cut out his comments from our local N.Cal paper before 2002. Dirty little secret is that male doctors often prescriibed hormone replacement for women so they would continue to be good bed partners to their husbands. They ignored the risks or it just wasn't studied because they really didn't want to even consider what the real truth and consequences might be. It changed my life, and not for the better. I no longer trust any dr. They have to prove to me they have my best interest at heart. Male dr. prescribed the hormones for me because I had no family history so he thought no risk Now they know better. 80% of women diagnosed have no family history.
What about bioidentical hormone replacenment?? Your report is not NEW!
Your news tonight was not new. For most woman, we have moved on to bio-identical hormone replacement. I'ts alot safer and has become more and more affordable. Check out Suzanne Sommers books for more information and Health benifits. We heard about Premrin years ago.
I have been taking bio-identicals for several years, and as much as it is touted as the safe alternative and actually reduces the possibilities of breast cancer, I would really like to know what kind of testing has taken place over the past few years. Would Bob Bazell please research this as well? and let me know!! Thanks!
I am a 50 year old woman going through menopause and had severe symptoms that not only interfered with my quality of life but with my mental functions. Exercise and botanicals did not have a significant effect. I went to my doctor and was put on hormone replacement therapy. I was warned of the risks related to cancer but willing to take the chance because I was so miserable. After a year, I tried to go off of them but my symptoms came back and were just as severe. Then I was lucky enough to find out about the Tahoma Clinic. Dr. Jonathan Wright MD is the medical director of Tahoma Clinic. He has done pioneering work in bio-identical hormone replacement therapy. After learning about and investigating bio-identical hormones I quit taking the hormones I was currently on. I have now started the bio-identical hormone therapy. There are no known risks of cancer. He has treated many patients over 30 years and none have had cancer issues connected with bio-identical hormones. I was very upset that my previous MD had not even told me that bio-identical hormone therapy was an option. Why would someone suggest something that helps, but has a risk of cancer when there is something that helps that does not have the risk? Because, big pharmacutical companies don't profit from bio-identical hormones--they can't be patented. Why isn't there a cancer risk with bio-identical hormone therapy? Because they are identical to our natural hormones and processing them does not have cancer causing results. Please check this out. If you really believe in spreading good news, you will be happy with what you find out. I believe that the public deserves to know about this option as well as any other. It has made a tremendous impact on my life and I would never go back to the previous medication. Thank you for your time and consideration.
This was an interesting study as I am currently researching the use of antidepressants for several symptoms of the menopause transition. Antidepressants have been shown to decrease both depression and vasomotor hot flashes and also in many cases improve sleep. It was interesting that this option was not mentioned in the report. It is true what the MD said that exercise is of course so useful in aging and with many medical problems.
This is very troubling in that I was very aware when the 2002 trials were stopped, but I had no alternatives for the symptoms. No one talks about vaginal dryness as an extreme issue for normal sexual activity. It had never been a problem until I was well into menopause, and then I suddenly realized what people meant. And we tried all kinds of lubricants. Ended up on a synthetic estrogen for awhile, then Prempro again, although I took it every other day, because I noticed it overstimulating my ovaries and breasts. Am still using Premarin cream for the vaginal dryness, and I am 14 years post menopause at age 62.
I was one of those who went on and off the PremPro and other estrogens. I have to think now that I am in the high risk category due to the many years I took the hormones. Now what?
Now 79, before 50 possibly peri-menopausal, I requested HRT from my GYN. Took 2 pills, estrogen and medoxyprogesterone. Some years ago, I read about Estratest, and made that change. Realized at that time,I had been testosterone deficient my entire adult life, rather sad to discover after 60.
I am part of the WHI, a control patient. In 2002, they advised me about halting the HRT Study, asking me at that time if I were to choose to continue my HRT, to please keep them advised of any medical issues. I complete a WHI medical questionnaire annually.
I am overdue for a mammogram, having been faithful up until recent times. I discussed HRT with my primary physician, and he suggested it was a quality of life issue. He accepted my decision to remain on HRT. Year or so ago, I asked him how his patients that opted out of HRT were doing, he said to a person, they were miserable.
FYI, I am intact, have all my original parts, minimal arthritis, take a pill for hypertension, and my 2 HRT pills. Resist and refuse Statins, returned to the workforce after 76, work 3 8+ hour days per week driving over an hour one way. Originally commuted via Sprinter, Coaster, Trolley and Bus 2.15 each way.
I am overweight and under-exercised. Do not take pain pills of any type. Look good and younger. Trolling for a life partner, would love to be sexually active.
I do believe caution is to be exercised, more genetic history using DNA for markers, prior to prescribing HRT. Simply taking it off the market is over reaction. IMHO.
My health care is via UCSD Physicians, I participate in various studies, and am part of Susan Love's Army of Women. Breast cancer should not be. The idea that the answer lies within persons who do not get this disease, makes sense to me. After the fact has not enlightened the medical community much at all.
I have attended several breast cancer lectures recently and I asked a surgical oncologist if bioidentical hormones were just as risky as the others. His comment was that both types of the HRT hormones are ultimately processed in the body as estrogen (even those derived from yams) and therefore increase the risk of breast cancer. I also know, because I work in the breast MRI field, that HRT increases breast density, which lowers the sensitivity of mammograms. Women with smaller/dense breasts and those who have other risks for breast cancer should go beyond mammograms and be screened annually with mammography, ultrasound and breast MRI starting at age 40 (earlier if strong family hx). Ask for a copy of your mammogram reports where now the ACR recommends that they include measurements for breast density. Breast imaging experts recommend that women whose breasts consist of at least 50% or more glandular tissue are at higher risk and should have additional screening done with ultrasound and breast MRI, especially if there is a lifetime risk of at least 15-20% when density is combined with other risk factors like family history and/or personal history of breast and/or ovarian cancer (see the American Cancer Society guidelines). Today's best breast centers will tell you that they have often detected breast cancers in women with dense breasts that were missed on mammograms but detected on breast MRI and found early enough for treatment to be life saving. If you are reading this post you already know there is risk but maybe are hopeful that you are ok. If you insist on HRT (I agree with the post about using anti-depressants like Trazadone for short intervals) then do the right thing and keep up with your annual breast screenings and be sure you get the ultrasound and/or breast MRI, too.
All of this news is very disheartening to me as a patient who had just been prescribed PremPro to alleviate increasing symptoms of post menopause. I have decided to stop the therapy immediately and wonder why would a Dr prescribe this treatment knowing the risk of cancer is so great. As a previous blogger suggests, most male doctors pooh pooh the symptoms we women face. It is time for the medical community to take some responsibility since we put our lives and health in their hands.
Most male doctors pooh pooh the symptons we face It is time for the medical community to take
some responsibility since we put our lives and health in their hands" That is the worst thing you can do. A
doctor, I will call him affectionately Dr. Seuss, said I had cancer and any doctor would tell me that. I didn't
buy and it turned out to be a harmonal imbalance. Best wishes to you. Phyllis Kunz