Hormone Replacement Therapy
What's a Woman to Do?

Hormone replacement therapy, or HRT, long prescribed to women to relieve symptoms of menopause and reduce heart attacks, is now causing controversy and confusion.

The dramatic headlines result from the Women's Health Initiative, a major, multicenter clinical trial sponsored by the National Institutes of Health designed to investigate the leading causes of death in older women. Baylor College of Medicine is one of the sites of the multicenter study which was halted when researchers found that women taking estrogen and progestin had an increased risk of breast cancer, heart disease, stroke and blood clots in the lungs.

As one of the principal investigators of the Women's Health Initiative, I am helping women understand the news.

This study addresses the risk of taking the combination HRT therapy of estrogen and progestin known as Prempro. Putting the risk into real-person terms, this "combination" hormone replacement therapy resulted in an additional eight per 10,000 cases of heart attacks per year, and an additional seven cases of breast cancer per 10,000 women per year. The increased risk of heart attack and stroke appeared early in the study, while breast cancer risks were not observed until five years of combination therapy. Estrogen plus progestin did have some benefits: one-third fewer fractures due to osteoporosis and one-third the cases of colon cancer.

How do you decide whether to use HRT? Consider your personal and family medical history, current health needs, and future concerns. Then talk with your health care provider to jointly decide what is right for you. If you continue taking HRT, try taking the lowest possible dose for the shortest possible time. Lower any other heart disease risk factors that you have. Walking 30 minutes three times a week cuts a woman's risk of heart attack in half. A healthy diet, stress management, treatment for depression and an optimistic attitude all help lower the risk of heart disease. Treating risk factors such as high levels of LDL cholesterol, triglycerides, blood pressure, and diabetes also reduces the risk of heart attacks and stroke.

If you decide to stop HRT, you can work with your doctor to find alternatives to help alleviate symptoms of menopause. Treatments such as creams, tablets and the vaginal estrogen ring help vaginal dryness. Some antidepressant and blood pressure medications improve hot flashes. Doctors can also prescribe drugs to prevent or treat low bone density or osteoporosis.

The Women's Health Initiative findings remind us that we are responsible for the choices we make to protect our health and quality of life. Together with our health care providers, we should all regularly assess our own disease risks so that we will enjoy vital and healthy post-menopausal lives.

Finally, because of the study's 163,000 participants, we are getting answers to many of the questions we have about women's health. Thanks, ladies.

Jennifer Hays is an associate professor of medicine at Baylor College of Medicine.

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©2006 Texas Medical Center

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