The Truth about Hormone Therapy

by Molly M. Ginty

Whatever stage of life you’re in, and whether you’re physically fit or living with chronic illness, you can find ways to be a wise steward of your health and well-being. Our health and wholeness are important keys to responding to God’s call for us and acting boldly on that call. That’s why Women of the ELCA have embarked on a new health initiative: Raising up Healthy Women and Girls. This ongoing column represents our commitment to the issue of women’s health.

The news rattled Marilyn Kentz even more than the hot flashes and mood swings she suffered.

"When a 2002 study found that the drugs I was taking for menopause could increase the risk of heart attack, I was shocked and terrified," says Kentz, 58, a writer in Los Angeles. "My father died of heart disease at the age of 42. I was determined to avoid his fate, so I quit hormone therapy as soon as I heard about the study’s results."

Without her daily doses of synthetic estrogen and progestin, Kentz suffered hot flashes that kept her up nights and mood swings that left her weeping inconsolably. After a six–month break from medication, she started using the Femring, a vaginal ring that releases estrogen and that, taken along with progestin pills, has helped her feel much better.

Health advocates say that one–third of the 18 million women who once used hormone therapy are likely going without treatment or trying alternative remedies.

First prescribed in the late 1960s, hormone therapy drugs — either an estrogen-progestin combination or an estrogen-only version for women who have had hysterectomies — were touted as the "cure" for menopause (the stage when women stop menstruating and estrogen levels drop) and as protection against heart disease and breast cancer.

Then came the July 2002 publication of landmark research in the Journal of the American Medical Association. The federally funded Women’s Health Initiative study, which enrolled 161,000 women, found that hormone therapy causes slight increases in the risk of breast cancer, heart attacks, strokes, and blood clots and that these risks outweigh the drugs’ benefits of minor protection against colorectal cancer and bone fractures.

Thus began a series of blows to hormone therapy’s reputation. Follow–up studies by Women’s Health Initiative researchers showed that estrogen–progestin therapy can increase the risk of dementia, and that combination and estrogen–only therapy can cause urinary incontinence. Other studies showed that combination therapy can boost the risk of breast and endometrial cancers, prompting the United Nations’ International Agency for Research on Cancer to reclassify the medication as "carcinogenic" instead of "possibly carcinogenic."

In the wake of these developments, sales of synthetic hormones plummeted 40 percent, and alternative remedies began to abound.

Instead of taking conventional hormone therapy, menopausal women started trying estrogen creams, gels, and patches that deliver estrogen through the skin instead of in the pill form studied by the Women’s Health Initiative. They took serotonin reuptake inhibitors (anti–depressants including Effexor) to ease hot flashes, and bisphosphonates (including Fosamax and Actonel) and selective estrogen receptor modulators (including Evista) to maintain bone density.

Women also snapped up "bioidentical" hormones (plant-based estrogens derived from yams and other natural sources and sold under such names as Prometrium and TriEst) and health store remedies including the herbal supplements black cohosh and phytoestrogens (found in soybeans, legumes, and whole grains, these mimic human estrogen).

Were these women making the right move? Nearly four years later, the jury is still out. In November, the Food and Drug Administration issued warnings to 16 alternative hormone therapy companies for marketing unapproved drugs. But some women who take these remedies swear by them, and there are no widespread reports of adverse effects.

While the debate on alternative remedies continues, hormone therapy itself may be making a comeback. In 2003, separate studies commissioned by two drug companies found that a quarter of women who had stopped using conventional hor mone therapy had since resumed it.

Last year, Wyeth Pharmaceuticals, maker of Prempro and Premarin (the two drugs used in the Women’s Health Initiative study) released two low dose versions of each product with plans to market several more versions soon.

"Thus far, low-dose hormone therapy appears to be safe and effective and to relieve symptoms just as well as older, higher–dose versions," says Dr. Wulf Utian, director of the North American Menopause Society.

What’s the upshot for women seeking relief from the symptoms of menopause?

For now, the Food and Drug Administration recommends hormone therapy for women at high risk for the conditions the drugs can treat: hip fractures and cancer of the bowel or rectum. The FDA recommends that other women use hormone therapy only if they are plagued by severe menopausal symptoms such as mood swings, hot fl ashes, disrupted sleep, and vaginal dryness, itching, or burning.

Health advocates urge women who are already at risk for problems associated with hormone therapy (breast cancer, heart attacks, strokes, and blood clots) to steer clear of the drugs. They advise all menopausal women to discuss hormone therapy and alternative treatments with their doctors, to take the drugs in the lowest possible dose, and to use them only as long as symptoms persist.

While authorities continue taking a conservative approach to alternative treatments, scientists are beginning to study these remedies’ safety and efficacy. "We’re hoping that researchers will develop treatments that work as well as conventional hormone therapy," says Marilyn Kentz. "We’re hoping for remedies that can not only ease our symptoms, but also keep us in good health."

Molly M. Ginty lives in New York. Her work has appeared in Ms., Marie Claire, Redbook, and Women’s eNews.

FOR MORE INFORMATION
National Institutes of Health, "Menopausal Hormone Therapy Information" www.nih.gov/PHTindex.htm

Our Bodies, Ourselves, "Midlife and Menopause" www.ourbodiesourselves.org/book/chapter.asp?id=26

North American Menopause Society www.menopause.org

Article published in Lutheran Woman Today, July/August 2006