Women turn to untested hormone therapy

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An Australian study shows that fewer women are using hormone replacement therapy (HRT) for relief of menopause symptoms. Instead, women are turning to untested; un approved “alternative” treatments.

These data come from the South Australian Health Omnibus Study, in which thousands of volunteers have been interviewed regularly since 1991. According to a report in the medical journal Climacteric, the use of HRT among female subjects in the study peaked in 2000, when 22 percent of women over the age of 50 years were receiving it.

In 2004, according to the article, only 15.8 percent of women over 50 were using HRT, but use of untested alternatives was still rare. By 2008, however, conventional HRT use in women over 50 had fallen even further, to 11.8 percent, and the number of women taking unapproved treatments such as “bioidentical hormone therapies” or herbal supplements had climbed to 4.0 percent.

The decline since 2000, say the researchers, can be linked with confusing early reports from a large American study called the Women’s Health Initiative (WHI), which was halted ahead of schedule when it appeared that HRT produced adverse effects rather than benefits.

Since then, the authors say, “Despite more recent reassuring data and a reinterpretation of the Women’s Health Initiative results, with a more favorable risk/benefit balance for the vast majority of women who initiate hormone therapy near menopause, the media and public image of hormone therapy has often remained cynical, uninformed or misinformed.”

Dr. Alistair H. MacLennan at the University of Adelaide, the lead author of the Australian report, explained to Reuters Health by email that participants in the Women’s Health Initiative were, on average, 13 or 14 years past menopause when the study began. At that time, he said, researchers had not yet realized “that HRT can prevent the thickening of the arteries which accelerates after menopause when oestrogen levels rapidly fall,” but only if treatment begins within roughly five years after menopause. In women who are well past menopause, such as the Women’s Health Initiative subjects, “HRT cannot bore out blocked arteries or effectively help arteries already diseased and damaged with postmenopausal Atherosclerosis,” he said.

Unfortunately, MacLennan and his colleagues found that among today’s women in the 50-to-59-year age group period that is “the best and safest period” for starting HRT - 7.7 percent of women use unregistered, unconventional hormone therapies.

MacLennan also pointed out that risk statistics in medical studies often refer to “relative risk,” which shows the risk compared to a control group. “To know if it is clinically significant” - that is, if the result is worth a life-altering change - “one needs to calculate the absolute risk.”

“The relative risk in the Women’s Health Initiative was 1.26 and was (frighteningly) and wrongly interpreted by some media and public (to mean) that 26 percent of women would have breast cancer on HRT. The risk actually depends on the individual’s background risk for breast cancer and what HRT regimen she is taking and for how long,” MacLennan said.

For example,” he continued, in the Women’s Health Initiative the absolute risk of breast cancer after 5.6 years of combined estrogen and progestin therapy was increased by less than 0.1 percent per year, which “may to some women on combined HRT be worth the advantages, e.g., quality of life, bone, and possibly heart and brain protection.”

In an editorial, Dr. David Sturdee, President of the International Menopause Society, advises, “It’s extremely important that women receive the correct treatment, rather than try something which may have no effect or may even be harmful. I’d urge women to contact their doctor before starting any treatment for menopause symptoms.”

MacLennan concluded, “It’s an individual’s informed decision that counts, but (regarding) HRT the information has been poor.

SOURCE: Climacteric, April 2009.

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