Despite risks, hormone replacement therapy beneficial for severe menopausal symptoms

Renee Hunter, an avid skydiver, says hormone replacement therapy “basically saved my life.” It was the only effective remedy the Oldsmar woman found to ease her menopause-related mood swings and hot flashes.

JIM DAMASKE | Times

Renee Hunter, an avid skydiver, says hormone replacement therapy “basically saved my life.” It was the only effective remedy the Oldsmar woman found to ease her menopause-related mood swings and hot flashes.

Renee Hunter was talking to her child's teacher when a hot flash sent sweat pouring into her eyes, soaking her shirt. And that wasn't even the worst of it. Always a laid-back person, she suddenly found herself constantly angry and lashing out at her family.

What felt to Hunter like "an out-of-body experience" was the start of menopause. The Oldsmar woman, then in her early 40s, tried soy and homeopathic creams, but nothing helped until her doctor prescribed hormone replacement therapy.

"It's basically saved my life," said Hunter, now 60 and still skydiving and sailing. "When I've tried to back off (HRT), I still get some of the hot flashes and the mood swings, so in order to save my marriage I stayed on hormones."

Hormone replacement therapy has been controversial since a 2002 study linked it with an increase in breast cancer and other health problems, including some the hormones had been thought to prevent. Millions of women dropped their pills, but in the years since, many have stayed with them because they haven't found alternatives.

Some doctors have thought that if HRT does fuel breast cancers, at least they're not likely to be deadly tumors. But new research last month disputes that belief.

Even so, experts say the benefits of hormone therapy still can outweigh the risks in women who have severe menopausal symptoms that don't respond to other measures, provided they take the hormones for the shortest time possible.

"If you need hormone therapy to help you transition and you're a reasonable candidate, don't be afraid of it," said Dr. Stephanie Van Zandt, a ob-gyn who specializes in menopause treatment at Contemporary Women's Care in Clearwater.

• • •

During menopause, the ovaries gradually stop producing estrogen and progesterone, which control the menstrual cycle. The typical American woman goes through menopause at 51.

The transition, which can last for five years or longer, is marked by hormone fluctuations that can lead to symptoms that range from mild to nearly intolerable, including mood swings so severe they can lead to depression.

In the 1980s and 1990s, as many as half of menopausal women took hormones to relieve symptoms, and to cut the risk of heart disease and osteoporosis.

Then in 2002, the landmark Women's Health Initiative study, involving thousands of women, found the hormones actually increased the risk of heart attacks as well as breast cancer, stroke and blood clots. Use dropped off sharply.

Last month, WHI researchers released more bad news: Women taking estrogen and progesterone were not only more likely to get breast cancer, they also faced increased risks of dying from it.

But the odds aren't huge: Of every 10,000 women who take the hormones for five years, six more will die of breast cancer, said Dr. Richard Santen, a professor of medicine at the University of Virginia Health System.

And the WHI study had significant gaps, he noted. The average age of participants was 63. Very few women enrolled between 50 and 55, the age at which most start HRT.

For the early 50-somethings, "we basically have no data," said Santen, co-author of an Endocrine Society review of hormone therapy. It concluded that the benefits usually outpace the risks for women younger than 60 and within 10 years of menopause.

"For somebody over 60, it's a slam dunk — the risks outweigh the benefits (and) symptoms have largely resolved at that point," Santen said.

About half of the menopause patients at Dr. Beth Benson's St. Petersburg ob-gyn practice take hormone therapy. Benson weans most of her patients off by 60.

"It's not an across the board, this-is-for-everybody,'' said Benson, who treats mostly adults at All Children's Obstetrics & Gynecology Specialists. "We have to know family history, lifestyle, what symptoms they're having."

Women who have had hysterectomies, for example, only need estrogen, which experts say has not been associated with the breast cancer risk seen with the combination estrogen-progesterone therapy other women need.

And the latest WHI study only looked at one medication, a combo pill called Prempro. But experts note that so-called bioidentical hormones, touted as natural and individualized, are still hormones, and their long-term effects haven't been studied rigorously.

"People come in emotionally charged about hormones unlike any other medication,'' said Dr. Robert Wenham, a gynecologic oncologist at Moffitt Cancer Center in Tampa. "They don't come in emotionally charged about their blood pressure medication, which has risks, too."

• • •

Lauren Miller is among the women who think hormone therapy is worth the risk. The 53-year-old Tampa woman suffered from manic mood swings and sweats, all gone since she started taking a daily "happy pill," as she calls her Prempro.

"I love it. They should put it in the drinking water," said Miller, adding that she has friends who never took hormones and got breast cancer. "On the list of things that are going to get us in our environment, my hormones are way down on the list."

Letitia Stein can be reached at lstein@sptimes.com or (813) 226-3322.

.ts

Nonhormone

relief

From black cohosh to flaxseed and soy products, many women look for alternatives to hormone therapy to ease symptoms.

Trouble is, studies are mixed on them right now, with the better-designed ones not showing any benefit, said Katherine Newton, a Seattle epidemiologist whose menopause research is funded by the National Institutes of Health.

"The bottom line is in terms of alternative, not-pharmaceutical therapy things, there's nothing that's very strong right now," she said.

She conducted a large, randomized trial on black cohosh, a plant in the buttercup family used in American Indian medicine, finding no improvement among women using it compared to a placebo. Now she's studying a type of yoga said to provide cooling benefits.

"There are women who really do need help with their symptoms," she said. "But most women will go through menopause and it's a natural event and they will be okay."

Here are some measures that may help:

Hot flashes:

• Dress in layers; choose buttoned sweaters, not pullovers.

• Avoid triggers like alcohol and hot drinks.

• Lower your thermostat at night. If your partner gets cold, try a dual-control electric blanket.

Mood swings:

• Try relaxation exercises, meditation and other stress-reducing techniques.

• Eat right and exercise to feel in control of your body and cope with stress.

• Talk to a health care provider, who can help you assess and treat more-severe issues like depression.

Trouble sleeping:

• Try to go to sleep and wake up at consistent times.

• Keep the bedroom dark and cool. Use it only for sleep and sex.

• Avoid caffeine and alcohol late in the day.

• Try snacking on cereal or peanut butter on toast before bedtime. Milk and peanuts contain tryptophan, which helps the body relax.

Sources: North American Menopause Society; Katherine Newton, senior investigator and epidemiologist at the Group Health Research Institute in Seattle

For more information: The Hormone Foundation (www.hormone.org/

menopause); the North American Menopause Society: (www.menopause.org)

Despite risks, hormone replacement therapy beneficial for severe menopausal symptoms 11/03/10 [Last modified: Wednesday, November 3, 2010 6:32pm]

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