To My Patients,
Recently, I attended a hormone replacement conference in California.
While the
press continues to publish reports that are negative in nature, the
faculty at
this meeting presented several concerns about the Women’s Health
Initiative
findings that prematurely terminated the study group taking the
Prempro, or the
combined estrogen and progesterone treatment.
I'd like to share with you highlights from the hormone replacement
conference:- The estrogen only part of the WHI study is still ongoing and no
significant
increase in breast or heart disease has been found within this
group.
- While the study indicated that the relative risk of breast cancer within
the estrogen/progesterone group was 1.12 after 5 years, the press
neglects to compare this to other risks such as:
First pregnancy over 30 years of age – 1.48
Body mass index over 29 (obesity) - 1.48
College graduate - 1.36
Alcohol use over 5 glasses per day - 1.16
Delayed menopause over 51 years - 1.14
Current use of HRT - 1.12
Also, Dr. Leon Speroff, a most distinguished and respected
gynecologist from the
University of Oregon, pointed out that the average age of the
participant in the
WHI study was over 63 years of age when they first started the
Prempro and that
49% were either current or past smokers! These parameters make
it difficult to
extrapolate the findings to a healthy, non-smoking woman who enters
menopause at
50 to 53 years of age.
Does this change our recommendations? No. I feel that
the use of HRT for women
who are having significant symptoms of hot flashes and/or night
sweats and who
are healthy without medical problems with a current negative
mammogram and who
will continue to obtain mammograms every year, may take HRT up to
four years.
At this point, the patient may consider tapering off the hormones
and determine
if her symptoms are significant enough to continue its use.
For those on estrogen only (previous hysterectomy) these patients
may continue
on estrogen since the WHI study has not found any significant risks
factors to
date.
Several new hormone products have become available recently:
- Prempro Low Dose - A significantly lower amount of both estrogen and progesterone as
compared to Prempro 2.5
- FemRing – A unique delivery of low dose estrogen by the use of a
vaginal ring that is not felt, does not cause infections, and not
detected by a partner. It is changed every three months by the patient.
- Estrogen gel will be available shortly. This is a very popular method in Europe.
Remember two things when making a decision about HRT. Do what
is best for you
physically and emotionally. Your decision should be your
decision.
And remember
this saying:
For most people, no news is good news;
For the press, good news
is no news.
If you would like to schedule an appointment with me to discuss your
specific
HRT needs, please call our office at 281.893.1246.
Randy Birken, MD
http://www.gynfo.com
Click for access to the July 2002 Newsletter regarding this subject:
http://www.gynfo.com/enews/7-10-2002.html
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