Hormones safer for younger women, experts advise
Last Updated: 2007-01-25 16:12:57 -0400 (Reuters Health)
By Maggie Fox
WASHINGTON (Reuters Life!) - Women entering menopause who are worried about whether it is safe to take hormone replacement therapy got a little reassurance on Thursday from experts who said it is not as dangerous as many fear.
A new "position statement" from the North American Menopause Society outlines the pros and cons of taking HRT, and makes clear the risks of heart attack, stroke and breast cancer are much lower for younger women than older women.
"We are saying they are a lot safer than what the popular perception is out there in the real world," Dr. Wulf Utian, executive director of the North American Menopause Society, said in a telephone interview.
A highly publicized 2002 study called the Women's Health Initiative or WHI found HRT raised the risk of heart attack, stroke, breast cancer and other serious conditions.
After it came out, millions of women stopped HRT and sought alternatives. Sales of Wyeth's Premarin and the company's other female hormone replacement drug, Prempro, fell dramatically.
But the WHI involved women with an average age of 63, long past menopause, and Utian said that factor may have affected the study. Women typically enter menopause between the ages of 45 and 55, with the average age being 51.
"There is very little reason for old women to be taking these hormones," Utian said. "We regard perimenopause as young -- 45 to 55 in the year 2007 is young for a woman."
The Menopause Society, a nonprofit group devoted to the study of menopause and representing health specialists in the field, asked a panel of experts to review various studies that have been done. It does not recommend that women rush wholesale to get hormones.
But it says studies show they are very useful for helping reduce often-debilitating hot flashes and specific symptoms affecting the vagina.
"They can also have a snowball effect. They can produce secondary symptoms ... . She may be fatigued, and if she is fatigued she is going to say she is irritable, maybe blue, depressed. She may not perform as well on the job," Utian said.
"She may say she is losing her memory. But they are actually the result, I think, of deprived sleep (caused by) night sweats."
COPING WITHOUT DRUGS
Women with mild symptoms may be able to cope by avoiding spicy foods, which can trigger hot flashes; by opening windows; or by dressing in layers, Utian said. But a third of women going through menopause have moderate to severe symptoms.
"Under that circumstance, if you look at everything that's out there, only the hormones are highly effective," Utian said.
Antidepressants are effective about 60 percent of the time, he said, and placebos are 40-percent effective. "Which is why all the health store stuff, the stuff on the shelves, is 40 percent effective because it is essentially working as a placebo," Utian said.
The panel of experts was unable to come up with any specific guidelines, however, because so little study has been done and because there are so many hormone replacement therapy products and regimes.
The general advice is to take hormones only to relieve hot flashes, night sweats and vaginal thinning or dryness, and to take them for five years or less if possible.
Doctors once believed that HRT prevented heart disease and the bone-thinning disease osteoporosis and would routinely prescribe the drugs for those reasons, even if patients had no troubling symptoms from menopause.
It is possible the drugs help protect the health of younger women who take them, the Society found.
For example, a study last year in the Journal of Women's Health found that women who started taking the drugs as they began menopause had a 30-percent lower risk of heart disease than women who did not take them.
