What Now?

Making Decisions Regarding Hormone Replacement Therapy

Having been told of the positive benefits of hormone replacement therapy and taking pills for years, post-menopausal women everywhere were shocked when they turned on the nightly news in July of this year. News had broken that part of a study conducted by the Women's Health Initiative (WHI) had been stopped due to findings that linked increased breast cancer and coronary heart disease to women taking hormone pills consisting of both estrogen and progestin. Confusion and worry ignited in the 6 million American women who take these pills and are still looking for answers.

News of the study came with warnings, but few answers, and the questions are numerous: Should I continue taking my hormone pills? What are the benefits versus the risks? What if I only take estrogen? What are my chances of getting breast cancer or heart disease? What do I do now?

Carlton Pearse, M.D. and Chief of Obstetrics/Gynecology at St. Luke's Hospital urges women not to panic, but to educate themselves as much as possible about hormone replacement therapy and to talk to their physician before making changes.

"Unfortunately, the answers are not cut and dry," said Pearse. "The study did not look at all scenarios and so we must make decisions regarding hormone replacement therapy on an individual basis. If your friend's physician recommended she stop taking the pills, that doesn't necessarily mean that decision is right for you."

Decisions regarding staying on or stopping hormone replacements are based on a number of circumstances such as how long you have been taking the pills, the reasons why they were prescribed and your personal and family medical history. For example, a woman taking hormones for less than 5 years for relief of menopausal symptoms is still considered in a "risk-free window," but she might want to consider other options if she has a high incident of coronary heart disease in her family.

The WHI stresses that women should carefully consider all risks and benefits associated with estrogen plus progestin pills and, while not ignoring the study findings, remember the low individual risk.

According to the study, if 10,000 postmenopausal women with a uterus took a combination of estrogen and progestin pills and another 10,000 took a placebo, the group taking the estrogen plus progestin pills would have 8 more cases of invasive breast cancer, 7 more heart attacks, 8 more strokes and 18 more blood clots during one year. On the positive side, these same 10, 000 women would expect 5 fewer hip fractures and 6 fewer cases of colon cancer than the placebo group.

The following percentages represent changes in risk for the estrogen plus progestin group compared to the placebo group overall:

A 41 percent increase in strokes,
A 29 percent increase in heart attacks,
A doubling of rates of blood clots
A 22 percent increase in total cardiovascular disease, and
A 26 percent increase in breast cancer; but
A 37 percent reduction in cases of colon cancer,
A one-third reduction in hip fracture rates, and
A 24 percent reduction in total fractures.

The estrogen plus progestin portion of the WHI study, conducted over five and a half years (stopped short of the intended eight years), was based on 16,608 postmenopausal women age 50-79 who still had their uterus intact and were considered healthy at the beginning of the study. The study did not address the short-term risks and benefits of hormones for the treatment of menopausal symptoms or situations involving other combinations or dosages of estrogen plus progestin. To date, the study found no increased risk to women who already had a hysterectomy and took estrogen only.

For many women, the study raises more questions than answers. Dr. Pearse recommends that women get the facts, talk with their doctor and continue with preventive healthcare measures including scheduling regular mammograms after age 40 and taking steps to maintain cardiovascular health. He also urges women to remember that cardiovascular disease is still the leading cause of death among American women.