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by Susanne
J. Phillips, MSN, NP
In July of 2002, new findings were released to the public about the long-term use and risks of combined (estrogen plus progestin taken daily) hormone replacement therapy. These findings were part of the Women's Health Initiative (WHI), a 15-year study of ways to prevent heart disease, breast and colorectal cancer, and osteoporosis. This study began in 1991 and involves more than 161,000 postmenopausal women and is sponsored by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with other units of the National Institutes of Health (NIH).
One of the clinical studies consisted of 16,608 healthy women ages 50 to 79 with a uterus who took the daily regimen of combined estrogen plus progestin. This study was stopped early, because after 5.2 years of study, the therapy's risks outweighed its benefits. Results from this study indicate that if 10,000 women take the estrogen plus progestin for one year, as compared to 10,000 women not taking hormone replacement, 8 more will develop invasive breast cancer, 7 more will have a heart attack or other coronary event, and 8 more will have a stroke or blood clot in the lungs. However, of the 10,000 women taking this combination, 6 fewer will have colorectal cancers and 5 fewer will have hip fractures.
It has been noted that the increased risk for breast cancer does not appear in the first four years of use, however the risk for blood clots were greatest during the first 2 years of use. It should be noted that the WHI trial on estrogen use alone (women taking estrogen only with a hysterectomy) is continuing. Authors have not reported increased risk for breast cancer in this group.
So, What Goes This Mean for You?
Well, the study authors emphasized that women should not be
unduly alarmed, stating that the increased risks of breast
cancer applied to an entire population of women, not to increased
risks for individual women. Study authors report the increased
risk to an individual woman was less than a tenth of 1% per
year. However, authors agree that a decision about hormone
replacement use should take into account the woman's individual
risk for cancer, heart disease and osteoporosis.
Primary care providers such as physicians, nurse practitioners, certified nurse midwives and physician assistants have long recommended lifestyle modifications for the prevention of heart disease, stroke, colorectal cancer and osteoporosis. Each and every woman has the tools to prevent these diseases. They include eating a balanced diet rich in fruits, vegetables and complex carbohydrates that is low in fat, cholesterol, and sodium, smoking cessation (or never starting), daily exercise including aerobic and strength training, self breast exam, and routine preventive screening including PAP Smear/Pelvic exam, clinical breast exam, mammogram, cholesterol, blood pressure, and flexible sigmoidoscopy or colonoscopy. Contact your health care professional for recommendations pertaining to your age and risk.
Below are the recommendations from the National Institutes
of Health *National Heart, Lung, and Blood Institute and the
American College of Obstetricians and Gynecologists (ACOG)
pertaining to the daily use of combined estrogen plus progestin.
ACOG Recommendations
- Women who have been on combined estrogen/progestin therapy for a number of years should discuss their individual situation with their physician (authors note: or NP, CNM or PA).
- Women on short-term use of combination hormone therapy for relief of menopausal symptoms, it may be reasonable to continue use for this purpose, since the benefits are likely to outweigh the risks. ACOG continues to recommend that this be a personal, individualized decision, made after consultations between a woman and her physician and taking into account a woman's individual benefits and risks from such use.
NIH Recommendations
- Combined therapy should not be continued or started for the purpose of preventing heart disease. Women should consult with their doctor about other methods of prevention, such as lifestyle changes, and cholesterol and blood pressure-lowering agents.
- Women should consult their doctor and weigh the benefits against their personal risks for heart attack, stroke, blood clots, and breast cancer. Alternate treatments are also available to prevent osteoporosis and fractures.
- Women should keep up with their regular schedule of mammograms and breast self-examinations.
- Short-term use was not studied; women taking therapy for relief of menopausal symptoms may reap more benefits than risks. Women should talk to their doctor about their personal risks and benefits.
Additional Resources
National Institutes for Health: www.nih.gov
American College of Obstetricians and Gynecologists: www.acog.org
National Cancer Institute: www.cancer.gov
References
Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women
Principal Results From the Women's Health Initiative Randomized Controlled Trial
Writing Group for the Women's Health Initiative Investigators
JAMA. 2002;288:321-333
New facts about: Estrogen/Progestin Hormone Therapy
The Women's Health Initiative
http://www.nhlbi.nih.gov/whi/hrtupd/ep_facts.htm
Statement on the Estrogen Plus Progestin Trial of The Women's Health Initiative
ACOG News Release
July 9, 2002
www.acog.org/from_home/publications/press_releases/nr07-09-02.cfm |
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