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Experts Discuss Fallout of Halted HRT Study

They admit they don't have all the answers

FRIDAY, Oct. 25, 2002 (HealthDayNews) -- Experts who gathered for a conference this week on what lies ahead for hormone replacement therapy (HRT) admit that they still don't have all the answers, but expect more information in the coming months.

They attended a workshop to address the fallout from the Women's Health Initiative (WHI) study, which was abruptly halted earlier this year. In the study, women on HRT were found to have higher breast cancer and other health risks after staying on the regimen for 5.2 years or longer, compared with women not taking hormone therapy.

The two-day workshop, sponsored by the National Institutes of Health, was held in Bethesda, Md. The meetings were filled with presentations discussing the WHI study, other studies of hormone therapy, and the industry's view.

On some points, everyone agrees, says Dr. Barbara Alving, deputy director of the National Heart, Lung and Blood Institute, who helped organize the sessions. "Everyone agrees that hormone therapy is acceptable for the relief of menopausal symptoms," she says. "Hormone therapy is still the first choice for women with severe vasomotor symptoms of menopause."

But short-term use -- generally defined as five years -- is preferred, she adds.

"Long-term use of hormone therapy should not be given for prevention of heart disease," Alving says, citing another area of agreement. While experts used to think hormone therapy helped reduce the risk of heart disease, the WHI clearly shows it does not -- and actually raises risk slightly.

Women who abandon hormone therapy but are at high risk for osteoporosis, the low bone density that can lead to fractures, must take steps to prevent bones from getting more fragile, Alving says. Women should ask their doctor about alternatives to hormone therapy, such as the new bone-building drugs, to prevent osteoporosis, she says.

For women who have decided to discontinue hormone therapy, Alving says the general consensus is to taper down the dose rather than quit "cold turkey." This may help in reducing or keeping hot flashes at bay.

If hot flashes are a continuing problem after hormone therapy is discontinued, Alving says, many physicians now prescribe the SSRI class of drugs, such as Effexor (venlafaxine) or Paxil (paroxetine).

Soy protein and primrose oil, previously believed to combat hot flashes, have both proven to be disappointing, Alving says.

What's next from researchers? "There will be quality-of-life analyses, and more detailed analyses in relation to cancer risk," Alving says. More analysis of hormone therapy and mental functioning is expected, as well as analysis of hormone therapy and quality of life, she says.

For women anticipating that a new study will reverse the WHI study results, Alving says that will not happen. The new evaluations, she says, will reinforce the data already presented.

One other message is clear, she says. "There isn't a magic pill that will take care of all of this [hot flashes, heart disease risk, etc]. " Women need to "take care of their bones, lose weight if they need to, and exercise."

What To Do

For a copy of the WHI study report, go to the Journal of the American Medical Association. To see the statement released by another leading group, visit the American College of Obstetricians and Gynecologists.

SOURCES: National Institutes of Health Scientific Workshop on Menopausal Hormone Therapy, Oct. 23-24, 2002; Barbara Alving, M.D., deputy director, National Heart Lung & Blood Institute
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