5 good reasons for going on hormones
Empowered Patient, a regular feature from CNN Medical News correspondent Elizabeth Cohen, helps put you in the driver's seat when it comes to health care. Dr. Bernadine Healy can't even count the number of women who've complained to her about how tough it is to make the decision about hormone replacement therapy. "Women say, 'Oh it used to be so simple. Now it's so complex,'" says Healy, a cardiologist and former director of the National Institutes of Health. "And I tell them, 'Yes, it used to be so simple because it was wrong.'" This is what she means: Before 2002, it was practically standard operating procedure to put women on synthetic hormones as soon as they reached menopause. ("We were putting them in the drinking water," jokes Healy.). But that turned out to be not such a great idea. A study in 2002 found that hormone replacement therapy, or HRT, made women more vulnerable to heart attacks, strokes, breast cancer and blood clots. In droves, doctors yanked their patients off the hormones. Six years later, Healy and others are pleading for a middle ground -- a world where doctors don't paint women with a broad brush, but instead consider the medical needs of each individual woman. The stumbling block to this middle ground is that patients often don't know what are good (and bad) reasons to go on HRT. And it's not just the patients who don't know. "A lot of the doctors are confused as well," says Dr. Wulf Utian, executive director of the North American Menopause Society and a consultant in obstetrics and gynecology at the Cleveland Clinic. But there's some good news in this hormonal mess. Since 2002, a consensus has developed among the experts about legitimate and not-so-legitimate reasons for considering HRT. Here are the big five legitimate reasons: startclickprintexclude--> Many women -- probably about two-thirds -- have mild to moderate hot flashes and won't need hormones, he adds. "Generally speaking, they can get away with layering clothing, avoiding spicy foods, breathing techniques or yoga." sometimes because of the night sweats, sometimes because of hormone changes. HRT sometimes helps, Healy says. sometimes Studies have shown that HRT can cut down on bone fractures for women with osteoporosis, but it's not for everyone. "A younger woman in early menopause who has osteoporosis -- or risk factors for osteoporosis -- might benefit from HRT," Utian says. "Older women should use something else." (See page 14 of this NIH report for other ways to treat osteoporosis.) Women are at high risk for osteoporosis if they're thin, have a family history of osteoporosis, are lactose intolerant or smoke. or any reason -- understand the risks of hormones. "I tell women, 'I'll give you the prescription as long as you understand the risks and the responsibilities and come in for regular checkups to see to it that all is going well,'" Utian says. And what are some not-so-good reasons for going on HRT pills? Vaginal dryness and itchiness are better treated with estrogen creams, our experts say. Irregular periods should be tolerated, or treated with birth control pills, Utian says. And certainly don't go on HRT because you think it might prevent aging, heart disease or cancer. The NIH study in 2002 rejected those reasons. If you do decide to go on HRT, you need to keep several things in mind. First, take the lowest possible dose for the shortest possible time. That second part is pretty fuzzy. "The jury is still out. Is short-term two to three years? Five years?" Stefanick says. "When you go back to your doctor for checkups, ask, 'Should I go off it now?'" Another question for your doctor: whether you should go on estrogen alone or combination therapy (estrogen plus progestin). Each has its pluses and minuses -- see Page 10 of the NIH document. Choosing the right doctor is obviously of the utmost importance. Utian recommends an obstetrician-gynecologist rather than an internist. He recommends asking doctors how often they deal with hormone issues. "Some obstetricians are so busy delivering babies, they won't be spending much time on hormones," he says. |
