HORMONES – Should I or Shouldn’t I

No doubt you have all heard about the recent study regarding the use of combined estrogen and progesterone. Until ACOG (The American College of Obstetricians and Gynecologists) releases it’s final recommendations, they are temporarily recommending the following:

• Women who for a number of years have been on the combined estrogen/progestin therapy should not panic, but discuss their individual situation with their physician. The WHI study authors took pains to emphasize that women should not be unduly alarmed. The increased risks of breast cancer, heart attacks and stroke applied to an entire population of women, not to increased risks for individual women—which were very small, less than a tenth of one percent per year. The population risks, applied over several years to millions of women, make the increased risks an important public health concern. However, as for individual women, a decision about hormone use should take into account a woman’s individual risk for specific conditions that may be harmed or benefited by hormone use.
• With respect to women on short-term use of combination hormone therapy for relief of menopausal symptoms, the WHI authors note that although such use was not the focus of this study, it may be reasonable for women to continue use for this purpose, since the benefits are likely to outweigh the risks. Regarding a woman’s short-term use of combined estrogen/progestin therapy when indicated for relief of menopausal symptoms, ACOG continues to recommend that this be a personal, individualized decision, made after consultations between a woman and her physician and taking into account a woman’s individual benefits and risks from such use.

The results of this study do not change the statistics printed in the package insert. The study was originally designed to hopefully show that combined estrogen/progestin therapy decreased the risks to women. When this was proven not to be the case, the study was terminated. There was proof, however, that HRT did decrease the risk of osteoporosis and colorectal cancer. Also, women who have had hysterectomies and are taking estrogen alone have not been shown to be at an increased risk whatsoever

The North American Menopause Society (NAMS) concurred that the risk to the individual woman was very small; i.e., 38 cases on HRT as opposed to 30 cases on a placebo out of 10,000 women per year for breast cancer, 37 cases as opposed to 30 cases out of 10,000 women per year for heart attacks (generally non-fatal myocardial infarction), and 29 cases as opposed to 21 cases out of 10,000 women per year for stroke. The WHI study did not consider in its overall benefit-risk analysis a variety of other conditions that may be positively or negatively affected by HRT, such as gallbladder disease, diabetes, cognitive function, and quality of life.

In summary, our physicians feel that you should not panic—let the dust settle and wait until ACOG’s Task Force comes out with their recommendation. It will not be detrimental to your health to continue with your hormonal therapy for a while longer while you make an informed decision whether it would be best for you to continue or discontinue using hormone replacement. You may always make an appointment to discuss this with your physician. If you would like to have more detailed information from ACOG, you may visit their website at www.acog.com. You may also visit NAMS website at www.menopause.org.