Q: My doctor recently stopped my hormone replacement therapy. I don't really know why I had to take it to begin with. Is there anything I should be doing now for my health related to this issue?
A: According to a study published in the Journal of the American Medical Association (JAMA), the risks of taking hormone replacement therapy (HRT) – specifically, a combination of estrogen and progestin – were greater than the benefits. In other words, the risk of developing breast cancer, a heart attack, stroke, and blood clots actually increased with the use of this HRT combination. The news of this study caused chaos and alarm among physicians and patients because millions of women were taking HRT to help prevent disease as well as alleviate the symptoms of menopause.
The study acknowledged that there are still benefits to taking HRT – such as a reduced risk of colon cancer and fewer hip fractures compared to those who don't take HRT. Nevertheless the study showed that for the general population the risks outweighed the benefits. Research has not shown us yet whether those women who have had a hysterectomy and take estrogen therapy alone are at greater risk for these conditions.
The recommendation was made to have all women discuss the use of HRT with their physicians on an individual basis, consider the risks versus the benefits, and – unless it was absolutely necessary – women should, under the guidance of their physician, stop the use of combination HRT because of the health risks.
So…what do you do with all of this information? In your case, your physician probably originally prescribed the medication as a measure to help prevent disease and/or maintain bone strength. For others, HRT might have been originally prescribed to prevent and/or alleviate symptoms of menopause. A few points:
- Heart Disease Prevention. With new information, we now believe that HRT does not prevent heart disease and that in fact it might actually increase the risk of heart disease. Heart disease prevention should be handled through regular physical examinations and check-ups with your doctor; lifestyle behavior counseling such as proper nutrition, regular exercise, stress reduction, smoking cessation, and the use of drugs such as aspirin to keep the blood thin; medication to regulate the blood pressure; and cholesterol-lowering medication to keep cholesterol levels in check.
- Maintaining Bone Strength. HRT has been shown to help prevent osteoporosis, but there are other drugs that help maintain bone strength. In addition, getting enough calcium and vitamin D every day are important as are weight-bearing exercises that are done on a regular basis, such as walking or jogging. Regular bone densitometry tests should be done as ordered by your physician to monitor the strength of your bones.
- Menopausal Symptoms. Unfortunately, when it comes to alleviating menopausal symptoms such as hot flashes and vaginal dryness, estrogen really takes care of the job for most women. The current recommendation is that it might be reasonable for a woman to use low-dose, short-term HRT to alleviate the symptoms. But this should occur only after a woman has had a one-on-one discussion with her physician to discuss the benefits and the risks, has regular follow-up with her physician, and regular breast and mammography exams. There are other drugs available that might help women with these symptoms, although those drugs are not without their own potential side effects.
- Complementary and alternative therapies. There are a number of herbal products that have been used by women throughout the years to address the symptoms and conditions of menopause. Unfortunately, there is a lack of scientific data to support the widespread use and safety of most of these herbal products. In addition, if an herb has a property that is similar to estrogen, we don't know if the long-term use of that herb might cause the same problems as long-term HRT use and/or have other risks and side effects. Large research trials are needed to further examine the safety and effectiveness of herbal products as well as a governing body over such products to ensure that products are not contaminated.
- Certain vitamin supplements such as vitamin E, and herbs such as black cohosh, have been shown to help relieve hot flashes in some women in small placebo-controlled studies. But large trials are needed to support this. Mind-body techniques such as meditation and guided imagery have shown to be helpful for some women in reducing hot flashes and evening out the emotional ups and downs that sometimes accompany menopause. Acupuncture has also been shown to alleviate the symptoms of menopause in some women. As with any other treatment, you must be aware of the risks and the benefits and always discuss the use of complementary and alternative therapies with your physician.
Have a discussion with your physician to clearly understand the risks of HRT use, and weigh the benefits. Seek the advice of your doctor's current recommendations for the prevention and detection of heart disease, breast and colon cancer, osteoporosis, and the alleviation of menopausal symptoms. In addition, commit yourself to a healthy lifestyle in order to optimize your health and prevent disease! |
