Communications: Patient Education

Patient Education: Helping Women Decide if Hormone Replacement Therapy is Still an Option

Friday, May 9, 2003  
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Weighing the risks and benefits of hormone replacement therapy can be a difficult task for women these days. In the past, doctors prescribed hormone replacement therapy (HRT) because they hoped it could help guard against certain diseases, like osteoporosis, heart disease and cancer. However, new information from a recent landmark Women’s Health Initiative study suggests that for many women, the risk of using HRT may outweigh the benefits.

"There isn’t just one course of treatment for all women,” said Amy Bonifas, a Brooklyn Center family physician and member of the Minnesota Academy of Family Physicians. "Some women may want to continue relying on HRT to deal with the effects of menopause. Others may want to consider alternatives.”

Specifically, the WHI study found that the use of the combination HRT (containing both estrogen and progestin) called Prempro for five years or more resulted in a small increase in a woman’s risk of breast cancer, blood clots, heart attacks and strokes. For each of these problems, the increased risk was about 8 more events per 10,000 women per year, compared to women who did not use HRT. The same study also found women using this combined HRT had a decreased risk of developing colon cancer, fewer occurrences of fractures and possibly a decreased risk of developing Alzheimer’s disease.

"You really have to take a look at the patient’s family history and her personal risk factors before making a decision about HRT,” Dr. Bonifas said.

Since an estimated 10 million postmenopausal women in the United States currently use estrogen and combination estrogen with progestin products, there is good reason for patients and the medical community to show concern about the risks of using HRT. A few months ago, the Food and Drug Administration (FDA) even approved drug labeling changes that include a boxed warning that spells out the new risk information and emphasizes individualized decisions for every woman.

"Many doctors feel the short-term use of HRT to control menopausal symptoms is still safe for most women. What’s important is that each woman sit down with her family physician and figure out what is right for her unique circumstances,” Bonifas said. "Options can include no treatment at all, taking a lower dose of medicine, or switching to another type of treatment.”

Possible alternative treatments for menopausal symptoms and lowering the risk of other diseases include vaginal estrogen creams, antidepressants, soy products and certain herbal supplements. Other medications are available to help prevent and treat osteoporosis. Also, eating a healthy diet, maintaining a healthy weight, exercising regularly and not smoking can help protect against heart disease, osteoporosis and some types of cancer.

"Your family physician will be able consider your menopausal symptoms along with your risk for developing certain diseases, and then give you advice about what to do,” Dr. Bonifas said. "The key is for each woman to make an informed decision with the help of her doctor.”

The Minnesota Academy of Family Physicians is a professional association of approximately 3,000 family physicians, family medicine residents and medical students organized to assist family physicians in providing quality medical care in Minnesota. The MAFP is the largest medical specialty organization in Minnesota and is a state chapter of the American Academy of Family Physicians, one of the largest national medical organizations in the United States with more than 103,000 members.


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