Doctors: Too early for verdict on estrogen benefit

Women’s health experts at Northwest Hospital are taking a close look at a study released recently challenging long-held views on the benefits and risks of hormone replacement therapy, while trying to diffuse confusion for doctors and patients.

The study, released earlier this month in the Journal of the American Medical Association, details a survey of more than 10,000 women who had had a hysterectomy and who took estrogen-only hormone therapy for about six years.

The women, part of the National Institutes of Health Women’s Health Initiative study, were followed for about 11 years.

The study results seem counter to earlier findings that hormone replacement therapy raises the risk of breast cancer, stroke and heart disease, but doctors point out that the new study looked at a type of therapy that had not been studied closely before.

Traditionally, hormone replacement therapy was given to women who are in menopause or had it artificially triggered by a hysterectomy.

A combination of estrogen and progestin was standard therapy for women complaining of menopausal symptoms, such as hot flashes, mood swings and others. The progestin acts to protect the uterus from potential harmful effects of estrogen.

That therapy, although still in use, came under fire in 2002 when a Women’s Health Initiative study showed the hormone combination caused increased risk for breast cancer, heart attack, stroke, and blood clots. Since then doctors have been cautioned to prescribe only the lowest doses for the shortest amount of time to help relieve symptoms.

But the women in the study, who had had hysterectomies, did not need the progestin so they received estrogen-only therapy. It is specifically this group of women from which the surprising results were taken.

The study found that women who had had hysterectomies and received the estrogen-only therapy for about six years had a 23 percent lower incidence of breast cancer, compared to the women who took a placebo.

In addition, women in their 50s in the study on the estrogen-only therapy had lower incidences of heart attack and stroke.

“On its face it seems like a reversal,” said Dawn Leonard, medical director of the breast care center at Northwest Hospital. “But with the initial Women’s Health Initiative study, they really looked at combined [estrogen and progestin] therapy.”

While Leonard is hopeful about what the new findings may mean for breast cancer research and treatment she said it is too early make unequivocal decisions about using estrogen-only therapy to help reduce breast cancer, or heart disease and stroke.

“So much data needs to be found out,” she said.

For instance, Leonard said, “Would things be different if it was women taking estrogen for 10 years? Is there potential benefit for all risk factors?”

Risk factors include women with an elevated risk of breast cancer due to family history, a genetic predisposition, or women who have had several breast biopsies.

And although Leonard acknowledged that the new information might change the way hormone replacement therapy is perceived, or change breast cancer treatment, she said some information in the JAMA article was confusing, even for doctors.

“It said that taking estrogen reduces risk by 23 percent, but what if your risk is low to begin with?” she asked.

Leonard said the way hormone replacement therapy is prescribed has changed since the warnings about the combination therapy emerged.

“Historically, women were offered HRT if they had one hot flash,” she said, adding that it was accepted that it “prevented heart disease and stroke, keeps your brain working well, and keeps you youthful and young. But it had side effects.”

Leonard said there is more attention paid now to “symptom management.”

“Do we need to continue estrogen therapy if a patient is not having symptoms?” she said. “There is a risk to taking any medication.”

She said medications should only be prescribed for intractable symptoms, and a risk assessment should be done before taking any medication, including estrogen therapy, and that should be made on a case-by-case basis.

“Take it seriously,” Leonard said. “There’s no such thing as a risk-free medication.”

“Our grandmothers survived menopause without HRT,” she added. “We have to help patients manage symptoms with natural means and healthy means. Let’s exhaust the safest options first.”

Dee-Dee Shiller, director of the Women’s Wellness Center at Northwest, admitted being surprised by the study findings.

“I was not expecting a reduction in risk in the estrogen-only area,” she said. “After the Women’s Health Initiative Study [that showed risk from combined therapy] people had fears and went cold turkey.”

Shiller said she was most interested the findings on women in their 50s.

“In younger women there were less risks for heart disease – that was the most interesting part for me,” she said.

The study showed risk for heart disease and stroke increasing for women in their 70s.

And although she, like Leonard, sees the study as a hopeful sign for new treatments, Shiller said hormone replacement therapy should still be approached with caution.

“If we don’t know the risk factors – then it should be the lowest dose for the shortest amount of time,” she said. “But if you’re in your 50s and on HRT for less than seven years – that’s probably OK.”

She said one part of the study that raised questions for her was the type of estrogen used. Would, for instance, results be different if women were given estrogen that is more like human estrogen? The women in the study were given estrogen extracted from pregnant mare urine.

“Do these things completely change the results?” Shiller asked.

Shiller said the study of estrogen/progestin hormone replacement therapy that showed higher risk for breast cancer, heart attack and stroke, made many women fearful of trying the therapy. She said this estrogen-only study, although raising questions, may dispel some of that fear.

“Instead of everybody living in fear, it’s not horrible,” she said. “But I’m not going to change practices because of this one area.”

“The interesting part is that if you had a hysterectomy and removal of your ovaries when you were young, it may not be so risky to be on estrogen a while, until you’re older,” she added.

Silverton Hospital Network to host women’s health seminar

The Silverton Hospital Network will host a free event aimed at women’s health April 26 at 5:30 p.m. at the Silverton Hospital Family Birth Center.

Take Charge of Your Health will focus on raising awareness and providing education pertaining to women’s health issues and will also focus on prevention of potential problems.

Topics will include sexual, urological and bone health issues as well as breast cancer, found to be the No. 1 health concern among women according to recent surveys.

“The idea is to give women a lot of good information so that they will be able to make good health choices for themselves,” said Diane Dobbes, event coordinator. “These are issues that most women over 40 will face at some point in their lives.”

The conference will also include a 45 minute discussion on women’s health issues with surgeon James Nealon, M.D., urologist Michael Lemmers, M.D., radiologist Piper Rooke, M.D. and on-gyn Barbara Keller, M.D., all Silverton Hospital Network physician specialists.

Discussion topics will include breast cancer detection and surgery and problems brought on by menopause.

A demonstration called Standing Tall will take place along with a discussion on exercises meant to improve bone health and how to prevent the onset of osteoporosis.

Special door prizes and giveaways including an overnight getaway and spa package to the Oregon Garden Resort will be handed out.

The event will also feature food and interactive demonstrations, therapeutic massage sessions, a mini clothing boutique and a personalized health review.

“We want to empower women to take control of their lives and their health,” Dobbes said. “And the best way to do that is knowledge.”

Whole Family Health Launches New Website

Whole Family Health announced today the launch of its new website. The new Whole Family Health website provides Canadian families with information and resources relating to a range of health issues, including women’s health, men’s health, pediatric health, fertility, and pregnancy.

The new site also provides information on alternative health treatments such as acupuncture, Chinese herbal medicine, massage therapy, and mind body medicine.

“With the site, our aim is to offer a resource that will help families across Canada live healthier lives,” said Cecil Horwitz, owner of Whole Family Health. “We’ll be updating our blog frequently with articles written by our team of practitioners and other experts, so it will be a useful, practical source for information on health that people can keep coming back to.”

Information and articles on women’s health are featured, focusing on the various stages of life – from PMS, acne, and irregular menstrual cycles to fertility, pregnancy and menopause. Recent articles discuss the use of acupuncture in dealing with postpartum depression, ways to feel great during pregnancy, and using Chinese herbs to treat menstrual cramps.

On the subject of men’s health, visitors to the site can read about men’s fertility health as well as a variety of other men’s health issues including chronic pain, stress, headaches, back pain, frequent urination, and low libido. Recent articles discuss how the right diet can combat chronic back pain and how to reduce stress in daily life.

The Whole Family Health website also offers practical information on common pediatric health issues such as infant teething, asthma, and allergies. Parents will find articles on natural treatments for these ailments as well as for other common health problems such as earaches, rashes, colic, fever, and infection.

“In our experience, people are curious about the benefits of natural and alternative treatments and how they can be used to complement Western approaches to medicine and health,” said Horwitz. “We’re excited about this new opportunity to share our experience and expertise with the community.”

Whole Family Health
Whole Family Health is a health clinic located in Edmonton, Alberta, Canada. The clinic provides a range of health services, including acupuncture, massage therapy, Chinese herbal medicine, nutrition, and mind body medicine. Some of the health issues that practitioners at the clinic specialize in treating are chronic pain, stress, infertility, and pregnancy health.