Continued from Page 1

In the WHI study, more than 16,000 women aged 50 to 79 with intact uteruses were taking estrogen plus progestin. The results revealed that during one year, among 10,000 postmenopausal women who are taking both of these hormones, eight more will have invasive breast cancer than women who are not taking the hormones. Seven more will have heart attacks, eight more will have strokes and 18 more will have blood clots.

"We already knew that there was a slight increase in breast cancer and had been counseling our patients accordingly," said Pennie Bosarge, MSN, CRNP, RN, a teaching faculty member at the University of Alabama School of Nursing. "We also knew there was an increased risk of blood clots."

Also, the average age of the participants in the study was about 63, and women in this age group would have entered the study with more pre-existing health problems than if the average age had been in the 50s, said Anita Nelson, MD, professor of obstetrics and gynecology at the UCLA School of Medicine.

Nelson also pointed out that the WHI study didn't examine the benefits of hormones in relieving vaginal dryness, hot flashes, mood swings or other menopausal symptoms. The WHI study also confirmed that hormones decrease the risks of colorectal cancer and osteoporosis.

"For the vast majority of women, it's perfectly safe for them to stay on HRT," Nelson said. "For most of them, the benefits outweigh the risks, or they don't have risks."

At-risk groups

But the decision is more complicated for women who do have risks of breast cancer or heart attack, Nelson conceded. If a patient has conditions such as hypertension, diabetes and obesity, for example, Nelson said, she might try anti-depressants rather than hormone replacement therapy. But if the patient continued to struggle with hot flashes, then Nelson said she'd consider prescribing a low-dose estrogen.

"We want our medicine to be risk-free, but this isn't the reality," Nelson said. "But women need to know the risks they are taking."

She also advises patients to reassess their status each year because priorities can change over time. For some women, menopausal symptoms drag on for years, influencing the need for HRT. For others, the symptoms fade quickly and hormones may not be necessary a year later.

Although the WHI findings complicate the decision for some women, for others the discoveries have made the choice easier.

For those who were taking HRT mainly for heart attack prevention, for example, Drohobyczer said it might be wise to find other tactics to prevent heart disease. She advises these women to tackle the problem with exercise and changes in diet. Patients who were taking hormones strictly for osteoporosis prevention should consider other strategies to increase bone density, such as increased calcium intake and exercise.

Drohobyczer started noticing the symptoms of menopause when she was 47, and seized the chance to experiment with different forms of HRT. For her, the signs of menopause began with hair loss and a new habit of misplacing things.

"I also had no motivation, and I'd wake up from 1 to 3 a.m.," she said. "You can tell you are just not as quick mentally. Going through it myself was really helpful for talking to women because they felt I could understand what they were going through."

Alternative remedies

Drohobyczer experimented with Triest, a compounded drug that includes three different forms of estrogen: estrone, estradiol and esriol. Although this form of hormone replacement therapy hasn't been tested for long-term effects or approved by the FDA, Drohobyczer said the combination of Triest plus progesterone worked well in relieving her symptoms. This compound drug can bypass the FDA approval process because it's made from naturally occurring, non-narcotic compounds, but women who want to use Triest still need a prescription.