What to think about replacement therapy
Published 12:00 am Tuesday, July 16, 2002
I was as shocked as millions of other women about the recent news that hormone replacement therapy may do more harm than good, especially because I have been taking it for about seven years.
I was riding behind a city bus one day when, all of a sudden, I realized that the letters HRT, which stand for Hampton Roads Transit, have the same initials as hormone replacement therapy. Then I realized what the two had in common: when it was previously reported that hormone replacement therapy had good benefits and was good to take, it took women for a long ride for a long time. Now, the discovery that using this therapy has dangerous risks has confused women to the point that they are unable to decide when should they get off the ride, myself included.
The good news is that in five years those taking estrogen only (like myself) had no signs of breast cancer. However, the halt was called to the treatment with a combination of estrogen plus progestin or a placebo.
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In the meantime, television stations began to reveal more about the studies, making things more confusing. On WVEC Channel 13 News one day last week, it was made public that a five-year study revealed that breast cancer was up 26 percent, strokes 41 percent, blood clots 100 percent and heart attacks 29 percent.
On the &uot;Today&uot; show last week, Katie Couric interviewed Dr. Lila Nachtigall, a professor of obstetrics and gynecology from New York University, who gave a complete opposite report of these findings. The interview uncovered some interesting and important views so I included most of it in this column.
Couric said that she wanted to get actual true facts about the study because it seemed to contradict everything that we have been hearing about the benefits of HRT.
&uot;After eight years if you look at the match-ups of who was on placebo and who was on estrogen/progestin, it matched beautifully so it was a well designed study and very carefully carried out,&uot; said Nachtigall. &uot;The reason it is so confusing, if you really read the paper, all the statistics are not significant. In fact I saw in the New York Times that there was a small but significant increase in breast cancer. And actually even in the paper the report said that it didn’t quite make significance, so I think that it is not as alarming as we may think.&uot;
She said she looked at the good news of HRT, and that for the first four years there was absolutely no increase in breast cancer. She also said she thinks that around the country the average length of time of being on hormone replacement is 2.7 years.
&uot;Ninety percent of women take it at first for just menopausal symptoms and then many women feel so much better. I don’t think that people doing the study have looked at important issues of quality of life and other benefits of HRT, which are important. They were only looking in the study at heart disease, breast cancer, and a couple of other cancers including colorectal cancer. The colorectal cancer was really significant because hormone replacement therapy actually decreased the risk of colon cancer,&uot; she said.
Nachtigall said that as for the benefits and risks as determined by the study, blood clotting was the most significant finding that increased.
&uot;They believe, and I do too, that you have to have a tendency towards it, and there are a million factors that make you clot; however, if you have any of them and don’t know that you do, estrogen will make you clot more easily and early on.
Then Couric asked a very important question. If it wasn’t significant, why did they cancel the study?
&uot;I think that it was right to stop the study because they saw that the trends were there,&uot; said Nachtigall. &uot;The first four years the placebo group had more breast cancers than the treated group, but after four years every year it started to go up. I think that they said that this is a trend and before it gets really off from a trend, we want to stop it. We think we have the answers already so why spend millions of dollars? I think that it was very smart.&uot;
Well, after hearing this interview I concluded that this was too much thinking for me to comprehend. Why stop the study if they did it thinking this and that and not knowing? Why not spend the money and be sure? I then asked 10 friends to share their ideas with me about HRT.
My first question was ‘What were they going to do about it?’ Five women said that they were going to continue to take it because they were on estrogen only, three women were going to seek substitutes on the advice of their doctors, and one was undecided.
And then there was another woman, a retired nurse, who said that she felt so much better on estrogen, and that she had rather die feeling good than to have the flashes return, and besides, eventually we all had to die from something.
I then phoned a good friend whom I admire because she is a breast cancer survivor twice – first about 20 years ago and recently in April 2001. Through it all she kept the faith and never complained and has been on chemotherapy treatments many times.
I asked her what I should do about HRT because I didn’t want to go back to experiencing the hot flashes along with some anxiety that I felt before the therapy.
She answered, &uot;Evelyn, you do what you have to do and pray.&uot;
And that’s just what I did. Thank God, she may have saved me a doctor’s office visit.
Evelyn Wall is a regular columnist and staff writer for the Suffolk News-Herald.