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HRT's Risks, Benefits Becoming Clearer
Excerpt
By Kathleen Doheny, HealthDay
For women struggling with whether hormone
replacement therapy is safe, studies are now simplifying the decision:
In the short run they're fine, in the long term they're not.
That's the message a women's health
expert will present to colleagues at a reproductive health conference
in California Thursday.
More studies are yielding the same
conclusions as last year's Women's Health Initiative (WHI) study,
says Dr. Andrew M. Kaunitz, a co-principal investigator of the
WHI.
That study, which tracked menopausal
and post-menopausal women on combination estrogen and progestin
therapy, found an increased risk of breast cancer, strokes and
blood clots. The finding prompted investigators to halt the study
in July 2002. Women who had been told to stay on hormones for
life to control health problems ranging from menopausal symptoms
to osteoporosis were left confused, scared and exasperated.
In the wake of the WHI, other studies
and analyses of previous research have been published, Kaunitz
says, and they're "all forming a cohesive picture."
And it shows that combination hormone use long term by menopausal
women does increase the risk of breast cancer and other problems,
he says.
Kaunitz points to a study published
last month in The Lancet, in which researchers who tracked
more than 800,000 British women found those on hormone replacement
therapy were at greater risk of developing breast cancer and of
dying from it. The good news -- the risk seems to decline fairly
quickly after going off the hormones.
But Kaunitz and other experts say
there is still a role for hormone replacement therapy for
the short-term relief of menopausal symptoms such as hot flashes
or night sweats that can interfere with a woman's quality of life.
"Hormones remain the most
effective treatment we have for women with bothersome hot flashes,"
says Kaunitz, a professor and assistant chairman of obstetrics
and gynecology at the University of Florida Health Science Center.
"We are not talking about
lifelong therapy," he adds.
Rather, he advises hormone replacement
therapy at the lowest possible dose to manage menopausal symptoms
short-term. Periodically, he suggests his patients taper off and
then quit the medication to see if they still need it.
As long-term hormone replacement
therapy has fallen out of favor, some attention has shifted to
other ways of controlling symptoms.
For vaginal dryness, a common menopausal
symptom, Kaunitz suggests either VagiFem, estrogen tablets inserted
into the vagina twice weekly, or Estring, a removable ring that's
left in place for three months.
For hot flashes, the medicinal
herb black cohosh is often suggested. Researchers who presented
a new study on Sept. 7 at the American Chemical Society's annual
meeting say the herb may not work on estrogen receptors, as thought,
but on serotonin receptors. The finding increases the likelihood
the herb is safe, the researchers say.
To educate women about menopause
and their options for symptom relief, several national organizations
are hosting campaigns, including the U.S. Food and Drug Administration,
the American Society for Reproductive Medicine and the National
Women's Health Resource Center.
More information
For information on the menopause
and hormones campaign, visit the National
Women's Health Resource Center. Learn more about the Association
for Reproductive Health Professionals.
Reference
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