A youth pill? Or a deal with the devil?

MELONE E-mail: Click here Archive

© St. Petersburg Times
published July 16, 2002

Although she is many years dead, I have never felt closer to my mother than now. I remember her vividly at 50, complaining about the symptoms of menopause. I remember thinking how old she was.

To me, menopause represented loss -- no more chance for a baby, the inexorable decline of your looks. I also did not think I would ever reach 50, that somehow that birthday would skip me and go on and strike some other luckless woman.

But now that very particular birthday is bearing down on me, like a fast train, bringing menopause with it, and in my mind, the not-so-long prelude to old age.

Certain gifts come with this birthday: a smart alecky bouquet of black balloons and, until last week, perhaps a prescription for hormone replacement therapy, or HRT. And why not? If it was good enough for millions of other American women, it was certainly good enough for me.

The black balloons I may still get, but maybe not the HRT -- not after the landmark study released last week that reported the HRT drugs increase the risk of breast cancer, heart attacks and strokes.

HRT was developed to stop the worst discomforts of menopause -- hot flashes, night sweats -- and it has also been found to ease osteoporosis. But over the years, it came to be touted by drug manufacturers almost as a magic bullet, capable of staving off some of the worst of growing old, like heart disease.

The drug, frequently prescribed as Prempro, was a combination of the two hormones, estrogen and progesterone. It was the second most prescribed drug in America. Dr. Thomas McNeill, a St. Petersburg gynecologist, had hundreds of his patients on it. Now he and they are facing a dilemma -- to stay on the drugs or go off them.

"You've got risks if you take it," says McNeill. "You've got risks if you don't."

McNeill is telling his patients not to panic, to come in and see him and let them, together, figure out what they should do.

"They shouldn't just stop their medicine because they're scared."

The study seems to suggest that HRT could still be used in the short run, during the four to five years when many 50-ish women experience menopausal symptoms, everything from night sweats to trouble concentrating.

It's when women get past the immediate menopausal years that doctors may have to get creative, to find other drugs to treat their symptoms. Other drugs can, for instance, be used to help osteoporosis, still others to combat depression.

Or women can opt to stay with the devil they know, HRT.

The risk of heart attack or cancer, said another St. Petersburg gynecologist, Dr. Romeo Acosta, is small when compared to the quality-of-life improvements that come with taking HRT. Problems like mood swings, bladder control and vaginal dryness can all persist long after the hot flashes have ended, and HRT treats them effectively.

Already, said Dr. Acosta, some of his patients are saying they are willing to take the risks to live a more comfortable life.

I'm not quite there yet. I don't know what I'll do. Fifty is sounding pretty young to me.

The HRT study reveals, once again, that no drug is without risks: You're darned if you do, you're darned if you don't.

Seen in that light, the HRT results are not so scary. We were foolish to think HRT could be some magic bullet, some fountain of youth pill. We've been brought up short, reminded of just how much living is not a matter of clear answers to be nailed down, but bargains to be struck.

-- You can reach Mary Jo Melone at mjmelone@sptimes.com or (813) 226-3402.

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