The news that thousands of women
in a national study were suddenly being taken off hormone replacement
therapy ushered in a day of reckoning for the millions of other women
who take hormones. They all had the same simple but vexing question:
Should I quit, too?
As their doctors scrambled for answers,
a consensus of sorts seemed to emerge, in which hormone users were
divided into two categories: women who had taken them only a year
or two to treat hot flashes and other temporary symptoms of menopause
and those who had taken them for years.
In the short-term, doctors said, hormone
replacement therapy still seems safe. But it does not look as promising
as it once did for a woman's long-term health.
"If a woman has only been taking
hormones for a year or two to treat hot flashes," said Dr. Lori
Mosca, director of preventive cardiology at New York Presbyterian
Hospital, "it's probably safe for her to go on. But if she's
been on hormones for 10 years, it's time to stop."
For many women, the choice to quit or
continue hormone therapy will not be easy.
Some said yesterday that increased risk of breast cancer, heart disease
and blood clots found in the study did not seem great enough to warrant
going off hormones.
"I've read the reports," said Rosemary Herpel, 59, of Shaker
Heights, Ohio. "We're talking about 8 more people in 10,000 who
got breast cancer. I just think that's not significant enough to make
me stop. I'm very concerned with bone loss. I have friends who haven't
taken hormones, and they are experiencing bone loss."
Janice Kennedy, 56, a third-grade teacher
in Lima, Ohio, said: "I'm really not buying what they're selling.
I know their studies have documented numbers, but for me, hormone
replacement has been beneficial."
Ms. Kennedy sees her doctor once a year
and has regular mammograms and pap tests. Because she is on a low-dose
estrogen patch, and progestin in pill form, and there is no breast
cancer in her family, she feels safe.
Many women who take hormone supplements
to treat temporary symptoms of menopause may decide to continue, said
Roger A. Lobo, professor of obstetrics and gynecology at Columbia-Presbyterian
Medical Center in New York.
"If a woman wants to take estrogen
and progestin for her quality of life, my recommendation would be
that she take the hormones in low doses and that we monitor those
doses once or twice a year," Dr. Lobo said. "And she should
have mammograms once a year."
Hot flashes, which are caused by fluctuations
in natural hormones, typically last only a couple of years, as women
go through menopause, doctors say.
Dr. Lobo said he commonly prescribed
hormone replacement therapy in doses that were only half as large
as those used in the Women's Health Initiative study.
One patient, Dr. Lobo said, is determined
to remain on hormone replacement therapy in spite of being at some
risk for breast cancer. "We've tried to take her off before,"
he said, "but she has such bad hot flashes, she can't sleep,
and it affects her work."
But the study did not specifically address
whether women at high risk for breast cancer are any more likely to
get breast cancer when they take the hormones. Doctors will be less
likely to recommend hormone replacement therapy for women looking
to prevent heart disease and preserve their long-term health.
"We have to stop using the drugs
for healthy women," concluded Dr. Maura Parker Quinlan, a hormone
replacement therapy specialist at the University of Chicago Hospitals,
who is now recommending that her patients stop taking estrogen and
progestin. "The risks of breast cancer, stroke, heart attack
and blood clots outweigh the benefit for bones. And we have other
drugs we can use to prevent osteoporosis."
Deborah Bublitz, 69, a pediatrician in Littleton, Colo., said she
would go off the hormones immediately, "but I just hate to think
about suddenly getting menopausal symptoms."
Dr. Bublitz started hormone replacement
therapy 11 years ago. She appreciated the relief from hot flashes,
night sweats, frequent urination and mood swings.
"When I started hormone therapy, I felt like I was riding in
a car that suddenly got shock absorbers," Dr. Bublitz said. "I
stopped reacting to little things as if they were big things. My energy
was better. I could remember people's names again, or where I put
this or that."
But the new findings make her worry
that supplemental hormones could be bad for her cardiovascular health.
"I still work 12-hour days," Dr. Bublitz said, "and
the thing I would worry most about would be a stroke or a heart attack
that would leave me handicapped for many years."
Copyright 2002 The New York Times Company
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