Have a question about women’s health or menopause? Dr. Patricia Yarberry Allen may have the answer. Click here to send in your question to be posted on WVFC.

Question: I am just furious. I don’t know why you doctors can’t make up your minds about what kind of treatment is best for women who are in menopause. I began hormone therapy with Prempro when I was 48 and having very irregular periods, terrible night sweats, embarrassing day-time hot flashes and sweating, no energy and a really bad mood. I had no interest in sex, either.

I felt like my old self in two weeks. I slept through the night. I had no hot flashes. My energy and mood were just fine. Then, when I was 52, in July 2002, I read in the newspaper that I could have a heart attack or a stroke from these drugs and that my risk of breast cancer was really increased as well. Of course, I could not get my doctor to answer the phone for weeks, so I just went off the hormone therapy cold turkey.

I still have problems with hot flashes and sleep and of course my energy isn’t so good either because I don’t sleep well. And forget sex. Now, I read that the big study that caused me to stop my hormone therapy wasn’t all that it appeared to be. I told my gynecologist that I wanted to go back on my hormones and he refused. What is going on? – Ann P.

Dr. Pat: This is a question all gynecologists dread. The truth is found in shades of gray, not black and white. Prior to the Women’s Health Initiative study, scientific information indicated that most women would benefit from the use of estrogen and progesterone begun during the menopausal transition and continued for years and years. The evidence available from studies indicated  that women who used hormone therapy would have less heart disease, no menopausal syndrome, improved sexual comfort and interest in sex, enhanced energy and mood, great skin, better bones and maybe less colon cancer.

This important study of more than 27,000 women was created to learn if hormone therapy decreased heart disease, osteoporosis and colon cancer. This scientific trial was designed to last eight years, but the estrogen/progestin arm of the study was halted prematurely in July 2002, because of increased health risks in the women who were taking these drugs. The estrogen arm of the study was halted for similar reasons in 2004.

Since the cessation of the study, scientists involved in the WHI have continued to sift through enormous data, working to clarify the risk and benefit analysis of hormone use, among other things. New analysis indicates that women who take estrogen alone early in the menopausal years may have less heart disease (as measured by coronary calcium scoring). Keep in mind, however, that this applies only to women who have had their uterus removed (as estrogen use can cause uterine cancer) and experts are still uncertain whether the benefits of estrogen will outweigh the risk.

Just last month, a Wall St. Journal story titled “How NIH Misread Hormone Study in 2002,” was later corrected after the WSJ received a letter from doctors Jacques Rossouw, chief of the WHI branch at the National Heart, Lung and Blood Institute, and Marcia Stefanick, chair of the WHI executive committee and a professor at Stanford University, commenting on what they believed were some inaccuracies in the story.

The story can be read online, but the letter itself is available only to subscribers. It is summarized here by Kaiser Daily Women’s Health Policy Report:

According to Rossouw and Stefanick, NIH and WHI researchers “are jointly responsible for all scientific articles arising from the study,” and both “parties stand by the original findings and conclusions.” The most recent analysis of data from the study, conducted earlier this year, “included some data not available” to researchers in 2002, Rossouw and Stefanick write. “The latest analyses add some further reassurance to women wishing to take hormone therapy in the short term for the relief of hot flashes and night sweats,” Rossouw and Stefanick write, adding, “They don’t provide evidence that even estrogen alone can help prevent heart attacks in the long term.” Rossouw and Stefanick conclude that “more effective options” than HRT use are recommended to lower heart disease risk, “including adopting healthy lifestyles and identifying and treating risk factors, such as high blood cholesterol and high blood pressure.”

What we know for sure is that a woman, almost a decade past menopause and 57 years of age, should not start hormone therapy again. The risk for heart attack, blood clots, stroke and increasing breast cancer related to your age and the time since you started menopause makes this a clear and easy answer.

The media often muddy the waters in matters of delicate scientific and health investigations. The media are interested in NEWS and want to be the first to break the story. In so doing, they sometimes do a great disservice to doctors and their patients. Health care consumers must remember that serious science takes time, evaluation and re-evaluation.

Certainly, all women owe a debt if gratitude to the NHI and its federal support that underwrote this important WHI study, for countering the unending pharmaceutical drumbeat that menopausal woman need to have their hormones replaced or suffer serious health problems.

As we continue to learn, all choices have consequences. The woman who is suffering from severe menopausal symptoms and is in the early part of her menopausal transition may choose with some comfort to use hormone therapy for a short period of time in low doses. This is not a drug treatment for life.

* * * * *
Dr. Patricia Yarberry Allen,
director of the New York Menopause Center, is a gynecologist affiliated
with New York-Presbyterian Hospital and a board certified fellow of the
American College of Obstetrics and Gynecology.
Have a question about sex, women’s health or the menopausal transition? Write to [email protected].

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  • Carolyn Hahn August 2, 2007 at 10:17 pm

    Great post, Dr. Allen. Thank you so much. IT IS SO HARD TO MAKE SENSE OF ALL THIS. I was wondering if I, with few obvious symptoms, was missing out on something by no taking whatever I could for it, but you’ve just clarified. There’s nothing to take for it, and if my symptoms aren’t that bad, it’s just life. Which is fine to say. I’d rather hear that than take something that causes cancer & /or heart attacks.