Solving the Hormone Replacement Therapy Puzzle
This article originally appeared in Be Well, a health
information newsletter published for members of the Greater Marlborough
Women suffering from menopause symptoms, such as hot flashes, night sweats,
dryness and mood swings, can be excused if they feel confused about
their treatment options these days.
For over 30 years, hormone replacement therapy (HRT), consisting of doses of
estrogen or a combination of estrogen and progesterone, was considered the
standard treatment for symptoms of menopause. Not only did HRT relieve the
discomfort, it was also believed to provide additional health benefits,
including protection against heart disease and bone loss leading to
This widely-held and accepted belief about HRT's long-term health benefits
was turned upside down two years ago when the National Institutes of Health
unexpectedly stopped two, long-term studies of HRT after it was discovered that
the risks appeared to outweigh the benefits. One study found that although
estrogen was very effective in relieving many menopause symptoms, it did not
reduce the risk of heart disease as previously thought. In addition, although it
was found to reduce the risk of osteoporosis and colorectal cancer, the
combination of estrogen and progesterone appeared to increase a woman's chances
of having a stroke or developing heart disease or breast cancer. The studies
estimated that the use of HRT could result in almost 7,000 additional strokes
per year nationwide. Although these numbers may seem relatively small, the
National Institutes of Health decided to stop the studies and issue a warning.
According to UMass Memorial Medical Center and Marlborough Hospital
obstetrician and gynecologist Peter Davidow, MD, the studies' findings and the
resulting publicity have been both a blessing and a curse. The studies provided
valuable information to physicians but left many women questioning the safety of
HRT. "It wasn't all that long ago that 80 percent of women experiencing
menopause were offered HRT. It was almost a given," explained Dr. Davidow.
"These studies made it clear that, as with any medication, there are benefits
and potential risks involved with HRT."
Last October, the American College of Obstetricians and Gynecologists
released new recommendations for physicians prescribing HRT. The professional
society reviewed all the data currently available, and concluded that for some
menopause symptoms, HRT was the most effective treatment but that the decision
on whether to use it should be made on a case-by-case basis and take into
account a woman's medical history and risk factors for heart disease and breast
For women who are appropriate for HRT and may not have found relief with
other treatments, obstetrician and gynecologist Kerri Osterhaus-Houle, MD,
stresses using the lowest effective dose of estrogen or estrogen and
progesterone and for the shortest period of time. "The evidence appears to
indicate that a decreased dose taken short-term as opposed to long-term can
further reduce risks yet still yield benefits," said Dr. Osterhaus-Houle. "The
pharmaceutical companies are now coming out with new lower doses. However, if a
woman is not appropriate for HRT given her medical or family history, we'll look
at other options together. And we follow all of our patients on HRT very
Abraham Fischer, MD, who is in practice with Dr. Davidow and Dr.
Osterhaus-Houle in Marlborough, said that many of his patients have expressed an
interest in alternatives to HRT for relief of hot flashes and other menopause
symptoms. Herbs, such as black cohosh and evening primrose oil, antidepressants
and a new form of estrogen derived from vegetables, called "phyto-estrogens,"
have all been reported effective to varying degrees.
"Although many women have reported good results using herbs, they should
always discuss these with their personal physician first," Dr. Fischer
explained. "The important thing for a woman suffering with menopause symptoms to
remember is that there are safe and effective treatments, and these can include
HRT. Women do not have to live with the discomfort."
Drs. Davidow, Osterhaus-Houle and Fischer all agree that the first step in
solving the HRT puzzle is for women to talk to their personal physician. He or
she can assess symptoms and medical history, discuss different treatment options
and partner with the patient in making the best decision.