Millions of women are dazed and confused. For decades they were told that hormone replacement therapy (HRT) would protect their bones, their hearts and their brains. If they worried about rumors of breast cancer, they were frequently reassured that the risk was minimal.
A year after the first bad news from the Women’s Health Initiative, the shock waves continue. This large, well-designed trial was halted early because HRT was doing more harm than good. Both heart disease and cancer were increased in women taking combined hormones.
Additional data now confirm that estrogen plus progestin increase a woman’s risk of coronary heart disease and stroke (New England Journal of Medicine, Aug. 7, 2003).
Another study published in The Lancet (Aug 9, 2003) followed one million women for more than four years. The investigators reported double the risk of breast cancer for women on combination HRT. Such compelling data leave millions of women and their doctors in the dark.
According to one reader, the whole topic is incredibly frustrating. “When the original study was stopped about a year ago, I called my gynecologist and asked for a recommendation. I was told that the study only involved older women and I should just ignore it.
“I started looking for a new doctor. When can we expect doctors to have some valid information for women? We always hear how carefully the FDA tests drugs, so now the question is–where did this go wrong?”
Perhaps the most shocking aspect of this whole story is that HRT has been on the market for more than 50 years. Estrogen and progestin have been the subject of more studies than almost any other drugs in history.
Despite such scrutiny, most physicians and patients were taken by surprise. Now millions of women are trying to figure out how to stop HRT without suffering unduly: “My doctor prescribed hormones for me when I first began menopause. After the research came out last summer, I told my gynecologist I wanted to go off hormones. I was told to taper off slowly.
“After five months, I began to feel very nervous, waking up in the middle of the night and not being able to go back to sleep. The symptoms became gradually worse. After consulting with my internist, I went back on the hormones daily and all those symptoms vanished. Will I ever be able to stop taking them?”
Gradual tapering of hormones may help some women avoid unpleasant symptoms such as hot flashes, night sweats, sleep problems, anxiety and vaginal dryness.
Others may get relief from soy and herbal products such as black cohosh.
To help women understand the complexity of this dilemma, we have prepared a Guide to Estrogen: Benefits, Risks and Interactions, which also discusses non-drug alternatives. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped (60 cents), self-addressed envelope: Graedons’ People’s Pharmacy, No. W-49, P. O. Box 52027, Durham, NC 27717-2027.
What does the HRT debacle represent for the thousands of other prescription drugs that will never get this kind of oversight? The take home message is sobering: We may never know the long-term safety of many commonly prescribed medicines.
The People's Perspective on Medicine