HRT for Menopause and the Health Risks: Just How Safe?
A new study in last Wednesday's New England Journal of Medicine offers both good and bad news to women suffering from the effects of menopause.
First, the bad news. New evidence from the massive Women's Health Initiative (WHI) study, completed in 2002, indicates that women double their risk of breast cancer when they take Prempro (a popular estrogen/progestin HRT drug) for at least 5 years.
Initial results from the study, reported several years ago, had shown that women taking Prempro had an increased breast cancer risk of 26%. Updated results were reported Wednesday by study co-authors Marcia Stefanick, a professor at the Stanford University School of Medicine, and Dr. Rowan Chlebowski of UCLA.
Now, the good news. That 50% increase in risk doesn't apply to women taking HRT for less than 5 years. And any elevated risk disappears entirely within 1 to 2 years of discontinuing the drug.
Prior to 2002, about 6 million women had been taking Prempro to combat hot flashes, vaginal dryness, and the bone density decline brought on by menopause. That number declined by about two-thirds when the National Institutes of Health issued a warning, based on WHI study results, that use of Prempro increased breast cancer, heart attacks, and strokes.
Within six months of that warning, breast cancer diagnoses showed an overall decline.
Wyeth, Prempro's manufacturer, continues to argue that the link between Prempro and breast cancer hasn't been firmly established. Joseph Camardo, Wyeth's senior vice president of global medical affairs, said, "It may be coincidence that as mammography was increasing in the late '90s, more and more cancers were being detected earlier, and when the study was halted, there's a coincidence in time."
But the study released Wednesday, along with noting the greater than expected breast cancer risk for long-term users, also found that changes in mammography usage weren't related to the drop in diagnoses.
Wyeth is currently facing more than 11,000 pending lawsuits from Prempro users.
"This is very strong evidence that estrogen plus progestin causes breast cancer," noted study co-author Stefanick in the New England Journal of Medicine Wednesday.
"I would encourage women to try and make it through menopause without starting hormone treatment,'' she added. "If you do start, go for the lowest dosage and the shortest duration."
Oprah Winfrey has recently tackled the HRT question, both on her television show, and in the current issue of her magazine, O. Despite its risks, Winfrey espouses a middle of the road approach to HRT, advocating a lower dose for a shorter amount of time-the same advice offered by many doctors who continue to prescribe HRT to their menopausal patients.
Winfrey adds that this approach may not be the right one for women who've already experienced blood clots, heart disease, or breast cancer.
Michelle Warren, MD, quoted in O, said, "If you look at the science carefully enough, the two-to-five-year period that most women need HRT to get through this transition is relatively safe." Warren is medical director of the Center for Menopause, Hormonal Disorders and Women's Health at Columbia University.
"Relatively safe." Does that mean HRT safe for you? As with many drugs, it depends on your current health; and your willingness to possibly put your long-term health at risk to address short-term concerns.
Bottom line, taking HRT is a personal decision. And only you can make it.