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Women Shunning Hormone Replacement Therapy

Finding that it poses health risks driving the trend, new research says

WEDNESDAY, Nov. 12, 2003 (HealthDayNews) -- Women are giving up hormone replacement therapy in record numbers, following the news last year that it may not be safe or helpful for a variety of menopause-related health concerns, including the prevention of heart disease.

That's the word from one of the first statistical studies of hormone replacement therapy (HRT) usage following a report in July 2002 that taking hormones may not have all the positive effects doctors once thought -- and could, in fact, increase the risk of some types of cancer.

Dr. Koon Teo, who presented his findings Nov. 12 at the American Heart Association's annual conference in Orlando, Fla., says women appear to be turning away from HRT in record numbers.

"We did not set out to do this study as a primary purpose -- we had been conducting a mega cardiology-related clinical trail involving 30,000 patients across the world, including over 8,000 women," explains Teo, a professor at McMaster University in Ontario.

But the Canadian study spanned the time period both before and after the July 2002 publication of the Women's Health Initiative (WHI) study on the effects of HRT. And it involved questioning the women about their use of HRT. So, Teo says he knew his research held some valuable information about the impact of the news about the use of hormones.

"Our study provided a snapshot of the women using hormone replacement therapy both before and after the publication of the study results from WHI. And by looking at that trend, we found that right after the publication of the results, there was a very sharp drop in the use of hormone replacement therapy by women who were being recruited for our trial," Teo says.

The Women's Health Initiative is an ongoing 15-year research project instituted by the National Heart, Lung, and Blood Institute. One goal of the project was to examine the risks and benefits of HRT in pre- and postmenopausal women. Before the study, doctors believed HRT might protect women against a host of health problems, including heart disease, cancer, osteoporosis and other age-related diseases, as well as the classic symptoms of menopause, including hot flashes and mood swings.

However, the early analysis of WHI data showed hormone replacement therapy appeared to have no benefits for the heart and might increase the risk of certain cancers, particularly ovarian and breast cancer. As a result, the part of the trial using the hormones estrogen and progestin together was stopped before completion.

Teo says that news prompted many women to give up HRT -- or never start it.

For menopause expert Dr. Steven Goldstein, the finding reflects a trend he sees in his own practice.

"Previous studies of pharmacy records have shown that prescriptions for HRT dropped dramatically after the publication of WHI results. But the change is also something I see everyday in my office. Women who were on HRT want to get off, and many of the women facing the opportunity for the first time are declining," says Goldstein, a professor at New York University's School of Medicine.

While Goldstein believes short-term use of hormone replacement therapy can help some women get through specific menopause-related symptoms, he also says any decision must be made on a case-by-case basis.

"The decision to use HRT and for how long must be made one woman at a time. And in order for a woman to make that decision, she has to turn to her own doctor, discuss her personal risk factors and her personal needs. This is not a decision a woman should be making on her own," Goldstein says.

However, it appears that many women are doing just that. In a new survey released by the National Women's Health Resource Center, up to 70 percent of women remain confused over the risks and benefits of HRT, and some 50 percent say they are getting their information through magazines or other media sources.

"While this statistic is understandable given the flurry of news over the past year and a half, it helps explain why women still need help in putting the study findings in proper perspective," Amy Niles, president and chief executive officer of the National Women's Health Resource Center, says in a statement.

"Furthermore, many women (42 percent of those surveyed) are not familiar with the many hormone therapy options that make individualizing therapy possible, such as patches, creams, vaginal rings and gels," she says.

The study done by Teo and his colleagues at McMaster included 6,623 women aged 55 and over who were involved in a national cardiology drug trial.

As part of the study protocol, the women were questioned on drug use, including hormone replacement therapy. The answers came in two waves -- first from a group who entered the trial before the WHI study release on HRT, and then from a second group who came on board after the WHI results were announced.

"The decrease in the use of HRT by women in North America after the WHI announcement was clear and unmistakable," Teo says.

The study found that nearly 6 percent of women in the cardiology trial were taking hormone replacement therapy prior to the WHI study release. That number dropped to just 3.9 percent after the news that HRT might not be so helpful.

Teo says statistics show a similar drop in HRT use among women in Europe and other parts of the world.

More information

For a summary of the WHI findings on the use of HRT, visit The Women's Health Initiative. To learn more about alternatives to hormone replacement therapy, visit The National Center For Complementary and Alternative Medicine.

SOURCES: Koon Teo, M.D., professor, McMaster University, Ontario; Steven Goldstein, M.D., professor, obstetrics and gynecology, New York University School of Medicine, New York City; prepared statement by Amy Niles, president and chief executive officer, National Women's Health Resource Center; Nov. 12, 2003, presentation, American Heart Association Scientific Sessions 2003, Orlando, Fla.
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