by Heather Creighton, Community Pharmacist
Several years ago, I spent a chilly spring day learning about the benefits of Hormone Replacement Therapy (HRT) for menopausal women. The take home message: most women would benefit from HRT, except those at risk for breast cancer. That was before the Women’s Health Initiative (WHI) study.
WHI, which set out to be an eight-year study, was sponsored by the National Institutes of Health and was looking at ways to prevent heart disease, breast and colon cancer, and osteoporosis. Recently, the results from WHI have been in the news, raising concerns among many women. The WHI study revealed that the use of HRT consisting of equine estrogen and medroxyprogesterone acetate taken on a daily basis increased the risk of breast cancer (increases were noted after four years). HRT also increased the risk of stroke, coronary heart disease, and blood clots (increases seen in the first year) according to the WHI study. Benefits of HRT included lower risks for hip fractures and colon cancer. There was no difference between the two groups on death rates.
On July 9, 2002, the WHI halted the study after 5.2 years, concluding that the risks for the study group on combined HRT outweighed the benefits.
A separate WHI trial on the use of estrogen alone in women who have had a hysterectomy was stopped in March 2004 because no overall benefit was found during 6.8 years of follow-up from the start of the study. WHI researchers concluded that conjugated estrogen alone should not be used to prevent chronic disease overall.
HRT is an effective treatment for the control of menopausal symptoms. However, only about 25 percent of women are symptomatic enough to consider this therapy. HRT is currently being prescribed at the lowest dose possible for the shortest duration of time. Patients initiated on HRT should be aware of the risks as well as the benefits.
Applying information from the WHI study is complex for both patients and health care professionals. The risks identified for the group of women using HRT, though significant enough to stop the study, were small for each individual woman. When it comes to HRT, there is no one-size-fits-all answer. Decisions about HRT will have to be made on a woman-by-woman basis. This means reviewing with your doctor why you want to be on HRT, your particular benefits with HRT use, and your increased risks with HRT use, taking into account your individual and family history for conditions such as heart disease and/or breast cancer.
There are alternatives to HRT for relief of menopausal symptoms in women (such as clondine, venlafaxine, phytoestrogens). Discuss these with your health care professionals.
Lifestyle is an important factor here as with any health condition. Follow Canada’s Food Guide, which recommends a diet rich in plant-based foods, low in saturated and trans-fatty acids, and high in dietary fiber. Increase your intake of water (six to eight glasses of water daily). Calcium and vitamin D intake are important for women. Reducing alcohol and caffeine intake may help lessen menopausal symptoms like hot flashes and insomnia. Smoking increases the rate of estrogen breakdown, thereby worsening symptoms of menopause. Regular exercise can reduce risks associated with elevated cholesterol levels, weight, heart disease, diabetes, and breast cancer.
