Hormone
replacement therapy (HRT) has been prescribed for years and to millions of
postmenopausal women. But the National Institutes of Health (NIH) recently
halted a major study that was part of the Women’s Health Initiative (WHI) when
the risks of combination HRT were found to outweigh the benefits.
The
latest evidence of HRT health risks has left many women with more questions
than answers. Here are some of those questions, with answers from NIH and other
medical organizations.
Q. What is HRT?
A. HRT is used to replace the hormone
estrogen, which a woman’s body stops making when she goes through menopause.
Combination HRT uses both estrogen and another hormone, progestin. Adding
progestin to the therapy helps prevent endometrial cancer in women who have a
uterus. Estrogen-only HRT is more often given to women who do not have a
uterus.
HRT was
developed to help alleviate the symptoms associated with menopause. It also
appeared to protect against heart disease and bone fractures due to
osteoporosis.
Q. What is the purpose of the WHI study?
A. Overall, the WHI is focusing on
prevention of major health problems, such as heart disease, breast and
colorectal cancer, and osteoporosis, which can affect a woman as she ages.
One component of WHI, the Estrogen Plus
Progestin Trial, was designed to study the effects of combination HRT on the
prevention of heart disease and hip fractures, and to look at any changes in
the risk for breast and colon cancer. It included 16,608 healthy postmenopausal
women between ages 50 and 79 with an intact uterus. The women were divided into
two groups. One group took estrogen plus progestin therapy, the other received
a placebo.
The study was
slated to last for 8.5 years but was halted in early summer 2002, after an
average 5.2 years of follow-up, when it became clear that the risks—especially
an increased risk for breast cancer—outweighed the benefits.
Q. What health risks were discovered?
A. Among women taking estrogen plus
progestin therapy, researchers found a 41 percent increase in strokes, a 29
percent increase in heart attacks, twice as many blood clots in the lungs and
legs, a 22 percent increase in total cardiovascular disease and a 26 percent
increase in breast cancer compared to women taking a placebo.
That means that
in a given year, for every 10,000 women with a uterus who are taking
combination HRT:
• Eight more
will have invasive breast cancer
• Seven more
will have a heart attack.
• Eight more
will have a stroke.
• Eighteen more
will have blood clots.
Q. Were there any benefits shown for HRT?
A. Yes. There was a 37 percent reduction in
colorectal cancer cases, a third fewer hip fractures and a 24 percent reduction
in total fractures.
In addition,
there was no difference in the total number of deaths between the women taking
combination HRT and those taking a placebo.
Q. What if I am taking combination HRT already?
A. Don’t panic. Your individual risk of
having any of these health problems because of HRT is actually very small—less
than one-tenth of 1 percent per year.
Still,
if you are currently taking HRT, you might want to talk to your doctor about
whether you should continue,
“Women with a
uterus who are currently taking estrogen plus progestin should have a serious
talk with their doctor to see if they should continue it. If they are taking
this hormone combination for short-term relief of symptoms, it may be
reasonable to continue since the benefits are likely to outweigh the risks.
Longer-term use or use for disease prevention must be re-evaluated given the
multiple adverse effects noted in WHI,” says Jacques Rossouw, M.D., acting
director of the WHI.
The concern
experts have is what even a small increase in risk could mean to a large number
of women taking HRT.
“Apply that
increased risk to an entire population, and over several years the number of
women affected increases dramatically and becomes an important public health
concern. Considering that millions of American women might consider taking the
estrogen plus progestin therapy, that could translate into tens of thousands of
cases of breast cancer or cardiovascular disease over several years,” says Dr.
Rossouw.
Q. What does this mean for women
considering HRT?
A. According to NIH recommendations:
• You should not
begin or continue combination HRT to prevent heart disease.
• If you are
thinking of using HRT to help prevent osteoporosis, talk to your doctor about
your personal risk for cardiovascular disease and breast cancer, and whether
the benefits would outweigh the risks. There are alternative therapies that can
help prevent osteoporosis.
• If you are
taking HRT on a short-term basis to manage menopausal symptoms such as hot
flashes, the benefits may still outweigh the risks. Again, talk to your doctor.
Q. What if I am taking estrogen-only
therapy?
A. Estrogen-only therapy is being
investigated in a separate WHI study. So far that study has not shown the same
significant health risks and is ongoing.
Q. What are other medical organizations
saying about the study?
A. The National Cancer Institute reminds
all women older than 40 to have a mammogram to screen for breast cancer every
one to two years.
The American
College of Obstetricians and Gynecologists recommends talking to your doctor
about your individual risk factors when deciding whether to begin or continue
HRT.
And
the American Heart Association advises that women do not start or continue
combined HRT for the prevention of coronary heart disease.
Q. Why is this particular study so
important?
A. It is the first randomized trial to
directly examine the long-term effects of estrogen and progestin on the
prevention of heart disease and hip fractures, while monitoring for possible
increases in risk for breast and colon cancers, in predominantly healthy women.
Previous studies were not able to provide definitive answers about the overall
balance of risks and benefits of combined HRT.
Q. Where can I get more information?
A. For more information, log on to
www.nhlbi.nih.gov or www.whi.org.
Upcoming Seminar Opportunities
Breast Cancer Awareness Month Seminar Series
Breast Cancer
Prevention
Featuring Dr.
Usha Venkatraj
Medical
Oncologist, Hope Cancer Center
October 17, 2002
6:00 p.m.
St. Joseph
Regional Health Center
Education Center
To register call
979-731-1231
Dr. Venkatraj
will be speaking on the three-legged stool of prevention (monthly breast
self-exam, annual clinical exam and mammography), as well as the use of
Tamoxifen as a preventive measure.
Gold Medallion
Lunch-n-Learn
Sharing the
Legacy of Breast Health
Featuring
Deborah Motley, MSN, RNC, FNP
October 22, 2002
11:30 a.m.-1:00
p.m.
St. Joseph
Education Center Annex (corner of Broadmoor and 29th Street)
Lunch Provided
$4 for Gold
Medallion Club members
$5 for
non-members
To register call
979-774-4653
Our speaker will
be discussing how to talk about breast health with daughters and
granddaughters, as well as the important role that senior women play in
creating a legacy of health in their families.
St. Joseph
Rehabilitation Seminar Series
Life After
Breast Cancer
Featuring Henry
E. Bohne, M.D. and Jo Johnson, St. Joseph Regional Rehabilitation Center
Lymphedema Program
October 29, 2002
6:00 p.m.
St. Joseph
Rehabilitation Center Quilters Café
To register call
979-731-1231
Our speakers
will be discussing the issues that are faced by women after a diagnosis of
breast cancer.
*Look for the fall issue
of Health
Scene (inserted in newspapers the week of
Sept. 16) for more breast cancer information. This issue will also feature our
Center for Sleep Medicine, Lymphedema rehabilitation program and new technology
in our surgery unit.