Hormone replacement therapy: Weighing the risks and benefits

photo File photo Debate continues over the value of hormone replacement therapy to treat women's symptoms of menopause. A 2002 study indicated the treatment was dangerous, but some doctors and researchers now say it has a place in women's health.

BY THE NUMBERSBetween 2001 and 2008:60 percent: Drop in total spent on HRT drugs.$3.3 billion: Drop in dollar amount spent on HRT drugs.70 percent: Drop in total number of HRT prescriptions.80.4 million: Drop in actual number of prescriptions.12.1 million: Drop in number of women receiving HRT drugs.Source: Agency for Healthcare Quality and ResearchHRT for menHRT is not exclusively for women. Men can benefit from it, as well, says Dr. Joey Bird of Chattanooga."It appears that men have a similar hormone crisis as they age with ever decreasing production of testicular testosterone," he says. "This has a detrimental effect on energy, mood, sex drive, mental concentration and maintenance of muscle mass."

Denise Leach was "miserable."

"I started having night sweats when I was around 47," Leach says. "A couple of years later, I heard about a study for menopausal women. I called and was a candidate. I had to keep a log of all my 'flashes' for about a six-week period."

The local Realtor, now 56, started taking hormones then and is still taking them today.

"I know there may be risks," she says, "but for me, it was about the quality of life."

Unlike millions of other women, Leach was not scared away from Hormone Replacement Therapy by the Women's Health Initiative hormone study, which in 2002 created a scare that caused millions to abandon HRT. The fear was propelled by the researchers themselves, who halted the study three years before it was scheduled to end after they became alarmed by what they'd already learned.

Involving 16,608 women ages 50 to 79, preliminary results from the study showed statistically significant increases in coronary disease, invasive breast cancer, stroke and pulmonary embolism in women being treated with estrogen plus progestin. Researchers concluded that the overall health risks exceeded benefits, according to the National Institutes of Health website.

The effect was huge. Between 2001 and 2008, the total number of prescriptions for hormone replacement drugs for adult women dropped 70 percent, according to a study conducted by the Agency for Healthcare Quality and Research, part of the U.S. Department of Health and Human Services.

But some researchers, doctors and others in the medical industry insist that the study was flawed and HRT is still a viable treatment option.

"The Women's Health Initiative presented the risk without considering age grouping risk differences," says Chattanooga physician Joey Bird, who specializes in obstetrics, gynecology and reproductive endocrinology.

"Criticism in some scientific circles led the researchers to re-evaluate based upon age groups (50-59, 60-69, and 70 and older)," he says. "The findings were comforting for women in the 50- to 59-year-old age group with no increase risk for breast cancer, blood clots, strokes, heart attacks and gallbladder disease. This indicates that the longer a woman is deficient in her hormone support, the greater the potential risk. So it is important to appropriately balance your hormones at the point of deficiency."

HRT is the process of supplementing the sex hormones -- estrogen, progesterone and testosterone -- when ovarian production diminishes and stops. While HRT can benefit women with menopausal symptoms, there are other conditions that lead to low sex hormone production that don't fall under the definition of menopause or postmenopause, he explains.

"These are typically younger women who develop loss of their menstrual production because the signals from the brain have stopped working. The egg quality is still good and they can become pregnant with replacement of the missing pituitary hormones. These patients would also benefit from HRT," he says.

HRT is available in patch, cream, lozenge, injection and pellet, Bird says. He prefers the patch.

"Anytime you bypass the stomach in delivering estrogen, you potentially reduce side effects and more closely supplement these hormones in the same way the ovaries once did," he says.

Dr. Rink Murray, a reproductive endocrinologist in Chattanooga, says HRT is an excellent choice for many women.

"It clearly relieves some of the symptoms associated with menopause and promotes bone health," Murray says. "It may even provide heart protective benefits, if given at the right dose and time in relation to menopause."

But there are women who shouldn't take HRT, he says. And, in some cases, patients believe, without an official diagnosis, that a physical symptom is caused by a hormone imbalance, he says. A doctor or clinic measures the patient's hormone levels and declares them all "low," then prescribes hormone therapy.

"If given in the wrong way or at the wrong time to the wrong woman, it can potentially increase the risk of heart attack, breast cancer or uterine cancer," Murray says. "There is a lot of fingerpointing these days, people who blame hormone imbalances as a cause of many symptoms. We see a lot of over-prescribing."

Taking the risk

Phyllis Mescon also is sold on HRT's benefits.

"I feel better and more alert," the 55-year-old says. "Losing estrogen was truly awful because I also lost my mental sharpness. I was always feeling as though I was walking in a fog. The estrogen patch does help."

But some women refuse HRT, even if they're suffering from menopausal symptoms.

"I would never consider HRT," says Lynda Hood, Chattanooga Bar Association executive director. "It would be doubly bad for me because I had breast cancer that was estrogen positive. I can't take estrogen at all."

Hood, who was diagnosed with Stage 4 breast cancer in 1997, is now cancer free.

"Had I not gone through cancer, I still would not do HRT because there's just so much we don't know about what it can do," she says. "Our bodies are supposed to go through menopause. It's natural."

Bird says he wouldn't recommend HRT to any woman who has had a diagnosis of breast cancer for less than two years or some patients with a history of blood clots.

"In many cases, these 'low' values are actually appropriate, so the added HRT actually gets these women above the level where they should be," he says.

But when the hormone levels decline, there is a price to pay, whether its diabetes (insulin), hypo or hyperthyroidism (thyroid), menopause (sex hormones) and adrenal fatigue, Bird says.

"Since estrogen, progesterone and testosterone receptors are present throughout the body, a decrease in production produces complaints -- hot flashes, night sweats, vaginal dryness, fatigue, insomnia, diminished sex drive and osteoporosis," he adds. "I believe for a vast majority of women around menopause, proper support of their hormones with HRT will allow for more effective work and home experiences and improve their quality of life without increasing their risk for side effects."


According to a recent report in the Chicago Tribune, natural options, such as black cohosh, have not proven to be effective in reducing menopausal symptoms, including hot flashes, but research is continuing.

" Researchers at the Botanical Center at the University of Illinois at Chicago are investigating the safety and efficacy of several plants, including black cohosh, red clover, chaste berry, valerian, hops and dong quoi," the report states.

"Breathing, relaxation techniques and clinical hypnosis show the most promise," it notes.

Rather than HRT, some women choose bio-identical hormones, which are chemically identical to those produced by the body produces, according to mayoclinic.com. But so are the hormones used in many Food and Drug Administration-approved hormone replacement products, website noted.

Bird says he's a big fan of giving something that's similar to what the body once produced.

"That approach is available through compounding pharmacies," he says.

Still, it's controversial. According to the FDA and several medical groups, bio-identical hormones may be riskier than those used in standard hormone therapy, and there's no evidence they're any more effective, mayoclinic.com reports.

Often marketed as a health tonic that's a "natural, safer alternative to dangerous prescription drugs," bio-identical hormones became popular after the Women's Health Initiative scared many menopausal women away from conventional treatment, according to the Chicago Tribune.

"The FDA has taken action against several pharmacies that make unsupported claims related to bio-identical hormones," the report states. "The use of custom-compounded bio-identical therapy is not recommended by mainstream medical organizations, including the American Medical Association, the American Society for Reproductive Medicine, The Endocrine Society and the North American Menopause Society."

Contact staff writer Karen Nazor Hill at khill@timesfreepress.com or 423-757-6396. Follow her on Twitter at twitter.com/karennazorhill. Subscribe to her posts on Facebook at http://www.facebook.com/karennazorhill.

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