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As the news about Hormone Replacement Therapy unfolds, women and doctors are looking for more tailored approaches for treating menopausal symptoms.
By SUSAN ASCHOFF, Times Staff Writer
© St. Petersburg Times, published July 30, 2002
Phone calls from frightened women flooded doctors' offices. Most of the doctors were reeling from the news as well.
Researchers this month abruptly halted the first definitive study on whether Hormone Replacement Therapy for menopause also protects women against heart disease, a benefit touted for decades. Researchers found that study participants instead suffered more heart attacks, blood clots and breast cancer.
The news was shocking, but many believe the impact will be positive. Women are asking more questions. Physicians wedded to pharmaceuticals are considering herbal supplements. The news should push doctor and patient to more carefully tailor their approach to menopause, some experts say.
"This data is not scary. It's fantastic. It means we're serious about treating women and getting answers," says Dr. Anna Parsons, a reproductive endocrinologist and associate professor at the University of South Florida.
Treatment of menopausal symptoms should begin with the simplest and most natural interventions, such as diet, exercise, even meditation, says Dr. Karen Mutter, an osteopath and founder of the Integrative Medicine Healing Center in Clearwater.
Soy, found in tofu, soy milk, soy nuts and other foods, is a natural source of estrogen to replace the hormone lost during menopause. So is flax seed oil, Mutter says. To ease symptoms, she also recommends B-complex vitamins and the essential fatty acids found in fish.
The best protection for the heart is to eat a low-fat, vegetarian diet supplemented with vitamin B12, says Dr. Samuel Jacobs, a member of the Physicians Committee for Responsible Medicine. To protect bone density, get lots of vitamin C and calcium from beans, green vegetables and fortified juices, Jacobs advises.
Aerobic and weight-bearing exercises keep the cardiovascular system healthy and strengthen bones to prevent osteoporosis, a loss of bone density that can cause breaks.
Some researchers have found the antidepressant Paxil reduces the number and severity of hot flashes in menopausal breast cancer patients. Because estrogen can feed cancers, doctors are reluctant to prescribe it for women with cancer risks. Similar effects were found with the antidepressants Prozac and Effexor.
Liz Fye, a St. Petersburg software engineer, has long experience with menopause treatments. Though her menopausal hot flashes were not severe, she took estrogen and progestin for several years because her doctors promised the drugs would cut her chance of a heart attack in half.
But the drugs had side effects. Fye suffered 24-hour bleeding, sleeplessness, racing heart, indigestion and constipation. Finally, she found a doctor willing to prescribe natural rather than synthetic hormones. She also changed her diet.
Today she is well, she says. And outraged.
"I'm extremely offended that women's health issues aren't being treated as important," Fye says of the years doctors prescribed Hormone Replacement Therapy as a magic bullet against heart problems.
"HRT doesn't prevent heart disease. It causes it," says Cynthia Pearson, executive director of the National Women's Health Network in Washington, D.C., in a statement.
"Women and their physicians were duped."
The HRT study was part of a mega research project called the Women's Health Initiative launched in the mid 1990s. It was the first to test a multitude of observational studies claiming a 40 percent to 50 percent reduction in coronary disease among users of estrogen or estrogen with progestin. Coronary disease is the No. 1 killer of women.
More than 16,000 women ages 50 to 79 were enrolled. Some received the drug combination; others got a placebo. They were to be followed for eight years. But at the end of three years, the relative risk of breast cancer among those on hormones had risen 26 percent. Instead of the 30 women in 10,000 who could be expected to develop breast cancer, 38 per 10,000 did.
The Women's Health Initiative participants on hormones might have in any one year seven more heart "events" per 10,000 women, eight more strokes and eight more clots than those taking placebos, the Journal of the American Medical Association said in its analysis.
Hormones apparently did reduce the incidence of colon cancer and hip fractures.
But breast cancer and heart problems would only increase over time, the journal concluded, regardless of a woman's race or age.
"It's not acceptable if eight or 10 die of a heart attack if it's your mother or sister," says Mutter, the Clearwater osteopath.
About 6-million women in the United States, or more than one-third of those who are postmenopausal, are on HRT. In 2000, 68-million prescriptions were written for Premarin and Prempro, the most frequently prescribed forms and the ones used in the study. The drugs are approved by the Food and Drug Administration to treat menopausal symptoms from hot flashes to bone loss.
"I'm not stopping mine," USF's Parsons says.
She and other physicians say their patients are often desperate for help, unable to sleep, suffering dramatic mood swings and painful intercourse. Most doctors say they will continue to prescribe hormones, but only for menopausal symptoms and for shorter lengths of time.
The average age for menopause is 51, but symptoms can begin years before menstruation ceases. The severity of symptoms varies widely from woman to woman. "I always start out talking about (estrogen) in food" and changes in diet to cope, Parsons says. "And they say, "Does it come in a pill?"'
Ideally, the most recent news on HRT will inspire new thinking about how women age and what to do about it, says Amy Allina of the National Women's Health Network and co-author of The Truth About Hormone Replacement Therapy: How to Break Free from the Medical Myths of Menopause (www.womenshealthnetwork.org).
The "change of life" is but another stage in a woman's life cycle.
"I think the ads (for HRT) have really done a lot to give the impression you don't have to suffer with menopause," Allina says. "Women's experience of aging continues to be defined as an aberration."
"It's not a disease," Mutter says. "It's an imbalance."
A medical myth has been smashed. This a good thing, Mutter says.
"It's our wakeup call."