Dr. Birken would like to take
this opportunity to respond to the Houston Chronicle Article dated
July 10, 2002 on Prempro. This article can be viewed at "Click for
more information" below.
Understanding the Issues from the Recently Released
Study Information Regarding Hormone Replacement Therapy
The National Heart, Lung, and Blood Institute
of the National Institutes of Health stopped a major clinical trial
on the risks and benefits of combination hormone therapy (estrogen
and progestin) in healthy menopausal women due to an increased risk
of invasive breast cancer.
The trial, part of the Women’s Health Initiative (WHI), also found a
small increase in coronary artery disease, stroke, and pulmonary
embolism.
The investigators reported a decrease rate of both hip fractures and
colon cancers in the study group.
It is important to note that no increase in breast cancer was found
among those women who were taking estrogen alone without the
addition of progestin.
Here is another way of interpreting the results:
If 10,000 women taking the combined hormone therapy for one year
were compared to 10,000 not taking HRT, you would see:
8 more cases of invasive breast cancer
7 more cases of heart attacks
8 more cases of stroke
8 more cases of blood clots in the lungs
6 less cases of colorectal cancer
5 less cases of hip fracture
The increased breast cancer risk did not appear in the first four
years of HRT, risks for blood clots were greatest in the first two
years of use, and the reduced risk of colorectal cancer was seen
after three years of hormone use.
An American College of Obstetricians and Gynecologists Task Force
will decide on clinical recommendations within the near future.
Until then, my patients have the following options based on these
clinical scenarios:
For those patients taking Prempro 2.5 or Prempro 5:
1. May stop this HRT without a need for tapering the medication
2. Switch to another estrogen/progestin (although we have no
clinical data on these hormones exist at this time)
3. Stop HRT and switch to soy/black cohosh herbal product
4. Stop HRT and continue to eat nutritional well, exercise, and take
Calcium 1200-1500 mg./day with Vitamin D 400 I.U./day
For those patients taking another estrogen/progestin product:
1. Continue on this product until further data is available
2. Stop this product without tapering the medication
3. Switch to a soy/black cohosh product
4. Continue with good nutrition, exercise, and calcium and vitamin D
For those patients taking estrogen only:
1. Continue on ERT until further data is available
2. Stop ERT without tapering the medication
3. Switch to a soy/black cohosh product
4. Continue with good nutrition, exercise, and calcium and vitamin D
For those patients who have been on HRT or ERT less than four years:
1. Continue on this product and stop at four years
2. Stop the product without tapering the medication
3. Switch to a soy/black cohosh product
4. Continue with good nutrition, exercise, and calcium and vitamin D
Remember, no conclusive studies have shown that an herbal product
such as soy/black cohosh gives one the assumed benefits of HRT
without the risk. Some patients have experienced less hot flashes
and night sweats when on these products. Please choose products that
are from a reputable source. If you like, there is a link on my home
page on Vitamins and Herbs that will take you to Rexall/Unicity, a
company that produces excellent products. Look up either Meno-basics
or Meno-Essentials and read about these products before purchasing
them.
Every patient must be managed on an individual basis since every
patient is unique. If you have further questions or concerns, please
call the office to schedule a consultation with me. And please
remember, don’t panic! These new findings must be analyzed and
interpreted by experts before specific guidelines are available to
our patients!
The information contained in this information regarding HRT and in
our online site is solely intended to provide broad consumer
understanding and knowledge of health care topics. This service is
for educational purposes only and should in no way be taken to be
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healthcare advice or services. The information should not be
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call, consultation or advice of your physician or other health care
provider. The information obtained from GYNFO.COM is not exhaustive
and does not cover all diseases, ailments, physical conditions or
their treatments. Should you have any health care-related questions,
please call or see your physician or other health care provider
promptly.
