Maureen Johnson
Daily Egyptian
Menopause often brings hot flashes and night sweats in its wake, but Jill DiMeo has managed to get through it unscathed.
DiMeo, 57, from Mt. Laurel, N.J., was approaching menopause and began to have sporadic menstrual periods. As part of a hormone replacement therapy, her doctor put her on estrogen every day and a progestin the first 10 days of the month. But after being on this combination of estrogen and progestin for eight years, DiMeo decided to discontinue the therapy.
"There was just so much controversy about it, the benefits and all, and I suggested to my doctor I might like to go off it," DiMeo said. "She didn't usually keep people on it longer than 10 years anyway. I didn't feel a particular difference when I went on them, and I don't feel a particular difference now that I'm off of them. I was on a low dosage, so maybe that had something to do with it."
Hormone Replacement Therapy, or HRT, is commonly prescribed to women for minimizing the symptoms of menopause. However, the findings of a 15-year study, the Women's Health Initiative, reported that the risks of HRT might actually outweigh its benefits.
Jennifer Hays, one of the principal investigators of the Women's Health Initiative, is an associate professor at the Baylor College of Medicine in Houston. She explained the Women's Health Initiative is a large study of women's health after menopause, with most women between the ages of 50 and 79.
"What was so surprising to those of us participating in the study as researchers was that many of us were told it was an unethical study or at least unnecessary," Hays said.
Prior to the study, the assumption was that women should be on hormones after menopause. This assumption was made on the basis of earlier data that just looked at women who happened to be on estrogen for a long period of time and compared them to women who were not.
The women who were on estrogen seemed to be healthier. They had fewer heart attacks, and they lived longer. It was presumed estrogen was the reason.
"When you find women who have been on estrogen for 20 years and you find a group who hasn't and you try to compare them, there are differences in those two groups," Hays said. "Women who are on estrogen for a long time tended to be pill-takers. They had access to medical care, and they controlled their blood pressure and their diabetes. They exercised.
"In every study, they were a healthier group to begin with. And the women who had breast cancer or maybe had a heart attack or stroke, those women were no longer in the study anymore."
However, the trial was stopped 5.2 years into the study because the number of breast cancer cases reached the predetermined number of cases at which the investigators would stop the study. Also, there was an increased risk of heart attacks observed rather than a decreased risk. There was also an increased risk of stroke and blood clots in the women using estrogen and progestin. Furthermore, it was seen that the women who used the hormones longer had an increased risk of breast cancer.
"Overall, the benefits, which are to lower our rate of fracture and colorectal cancer, are not outweighed by the risks," Hays said.
Lynn Chard-Petrinjak, communications manager of the National Osteoporosis Foundation in Washington, D.C., said HRT has been shown to prevent osteoporosis in women by increasing their bone density.
"If you have someone who has no risk for stroke, heart disease or breast cancer, but they're at high risk for osteoporosis, they might talk to the doctor about going on it," Chard-Petrinjak said. "But there are other medications approved by the FDA for the treatment of osteoporosis. A Selective Estrogen Receptive Modulator, which is what they call 'designer estrogen' has an effect on bone tissue, but it doesn't have an effect on breast tissue."
Chard-Petrinjak said the best prevention for osteoporosis is diet and exercise.
"Calcium and Vitamin D are so important, as well as getting weight-bearing exercise," Chard-Petrinjak said. "They're the best things you can do for your bones. Working against gravity will help maintain your bone mass."
Chard-Petrinjak said the study only looked at one preparation, so there may be more recent preparations that are lower in dosage but do not have as many side effects.
"The study with women who have had hysterectomies and are only on estrogen replacement therapy have not seen the same kind of risk to date they've seen with the combined HRT," Chard-Petrinjak said.
Hays said the study is only a start in looking at the effects of hormones on a woman's body. She explained it might prompt more research in the future.
"The next question is 'Why?'" said Hays. "Was it the progestin? Was it the combination of estrogen and progestin? Are there safer ways to deliver this medicine, such as through skin patches? Is the lower dose as effective and safer? We don't have these answers yet, and I think that's what we as women ought to be demanding."
Hays said oral contraceptives also contain estrogen and progestin, but they are different forms and in higher doses than those used in HRT. However, the effects of oral contraceptives on the body are different from those of HRT. Women who have taken them have a lower rate of ovarian cancer, and there is even some evidence that they protect women from breast cancer.
The only concern researchers have about oral contraception is the risk of blood clots. The package insert tells women not to take them if they're over the age of 40 or if they smoke. Oral contraceptives can cause clotting in the deep veins in the legs, and possibly in the lungs.
"Frankly, I find it unacceptable that we don't have more information about how women's bodies function during phases of their cycle pre-menopausally and then after menopause," Hays said.
DiMeo said that she was not concerned about the findings of the Women's Health Initiative.
"Anytime you put anything chemical into your system, someone is going to have some kind of reaction to it," DiMeo said. "I do believe that we do have a proclivity to conditions through our genetics. If I had a daughter, I would just tell her to find herself a good physician and know what she's taking."
Reporter Maureen Johnson can be reached at mjohnson@dailyegyptian.com.
Published on 11/17/05; 12:24:44 PM
