Hormone therapy:
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Choosing
whether or not to use postmenopausal
hormone therapy is an
important health decision. The
Women's Health Initiative and
other studies are providing important
information about the risks and
benefits of long-term menopausal
hormone therapy to offer women
some guidance about hormone use.
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Facts
About Menopausal Hormone Therapy
Brand new! Revised with updated information
following NIH's cessation of the estrogen-alone
study. Choosing whether or not to use menopausal
hormone therapy (MHT) can be one of the
most important health decisions women face
as they age. This 24 page brochure summarizes
the latest evidence as of Summer 2005 to
offer guidance about the risks and benefits
of MHT. It is designed to provide patients
with information to help them communicate
more effectively with their care providers
and determine the best course of treatment
on an individual basis. This easy to read
publication covers such topics as Menopause
and Hormone Therapy, Alternatives to Hormone
Therapy to Help Prevent Postmenopausal Conditions
and Relive Menopausal Symptoms, Dietary
Supplements, and more.
What
is the purpose of the WHI study on combination
hormone therapy?
The long-term studies in the WHI were initiated
because over the years a number of research
studies presented a complicated picture
of the risks and benefits of hormone therapy,
and its continued use for prevention of
cardiovascular diseases was controversial.
This situation led the NIH to conduct a
large clinical trial of the risks and benefits
of hormone therapy. The WHI set out to examine
the long-term effect of estrogen plus progestin
on the prevention of heart disease and hip
fractures, while monitoring for possible
increases in risk for breast and colon cancer.
The estrogen plus progestin regimen was
given to women who have a uterus since progestin
is known to protect against endometrial
cancer, a known effect of unopposed estrogen.
A separate study of estrogen alone in women
who had a hysterectomy was also begun.
What
were the actual hormones that women in the
estrogen-plus-progestin study were taking?
Women who were randomized to receive active
hormones were taking conjugated equine estrogens
0.625 mg each day and medroxyprogesterone
acetate 2.5 mg each day. This is the most
commonly prescribed postmenopausal hormone
therapy in the United States for women who
have a uterus (used each day by more than
six million women).
Do
you have recommendations about other hormone
alternatives (lower-dose estrogens, micronized
progesterone, natural hormones)?
We cannot make specific recommendations
about other hormone medications, such as
different estrogens or progestins. We also
cannot make recommendations about hormones
women take in lower dosages or in different
ways, such as patches instead of pills.Futher,
without scientific clinical trial data,
one cannot assume that alternative estrogen
plus progestin treatments are any safer
than those studied in WHI.
Postmenopausal
Use
Menopause may cause other changes that produce
no symptoms yet affect your health. For
instance, after menopause,women’s
rate of bone loss increases.The increased
rate can lead to osteoporosis, which may
in turn increase the risk of bone fractures.The
risk of heart disease increases with age,
but is not clearly tied to the menopause.
Through the years, studies were finding
evidence that estrogen might help with some
of these postmenopausal health risks—
especially heart disease and osteoporosis.With
more than 40 million American women over
age 50, the promise seemed great. Although
many women think it is a “man’s
disease,” heart disease is the leading
killer of American women.Women typically
develop it about 10 years later than men.
Furthermore,women are more prone to osteoporosis
than men. Menopause is a time of increased
bone loss. Bone is living tissue. Old bone
is continuously being broken down and new
bone formed in its place.With menopause,
bone loss is greater and, if not enough
new bone is made, the result can be weakened
bones and osteoporosis, which increases
the risk of breaks. One of every two women
over age 50 will have an osteoporosis-related
fracture during her life. Many scientists
believed these increased health risks were
linked to the postmenopausal drop in estrogen
produced by the ovaries and that replacing
estrogen would help protect against the
diseases.
Putting
It All Together
The WHI findings finally offer women guidance
about the use of menopausal hormone therapy.
They establish a causal link between use
of the therapies tested and their effects
on diseases. Further, the results apply
broadly— the studies found no important
differences in risk by prior health status,
age, or ethnicity. As you read the information
given below, realize that most treatments
carry risks and benefits.Talk with your
doctor or other health care provider and
decide what’s best for your health
and quality of life. Begin by finding out
your personal risk profile for heart disease,
stroke, breast cancer, osteoporosis, colorectal
cancer, and other conditions (See Boxes
11, 12, 13, 15, 16, 17, 18, and 19.). Discuss
quality of life issues and alternatives
to menopausal hormone therapy. Box 20 will
help you talk with your health care provider.
Then weigh every factor carefully and choose
the best option for your health and quality
of life. And keep the dialogue going—
your health status can change and so can
your choice.
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