Should I continue hormone replacement or not? Thousands of postmenopausal women want to know.

  The Womens Health Initiative study of hormone replacement therapy (HRT) was halted abruptly earlier this year because researchers found the risks of HRT outweighed the benefits.

  Baptist Online magazine talked to Dr. Susan Murrmann, MD, FACOG, Certified Menopause Clinician, of the McDonald Murrman Womens Clinic and Baptist Womens Hospital to find some answers.

  Its an individual choice, Murrmann said. Physicians have to go over every single detail with patients, inform them, and make them a part of the decision-making process.

  The Womens Health Initiative is a long-term study sponsored by the National Institutes of Health (NIH) that is looking at ways to prevent heart disease, breast and colon cancer, and osteoporosis in women. 

  The WHI hormone program studied two types of hormone pills. One is estrogen plus progestin in women who had not had a hysterectomy before joining the WHI. The other is estrogen alone in women who already had a hysterectomy before joining.

  One part of that study followed 16,608 women with a uterus, who were ages 50-70 when they entered the study, and who took either combined estrogen and progestin (sold as Prempro) or a placebo. The goal of this eight-year trial was to study the relationship between HRT and its possible benefits for heart disease and hip fracture, as well as its possible risks for breast cancer, endometrial cancer, and blood clots. 

  The WHI Data and Safety Monitoring Board (DSMB) recently reviewed the health status of women in the Womens Health Initiative. Based on this review, the DSMB recommended that:

• Women in the study of estrogen plus progestin stop their study pills, because the risks now exceed the benefits.
• Women in the study of estrogen alone continue taking their study pills as before, because it remains uncertain whether the benefits outweigh the risks.

  On July 9, 2002, the NIH halted this trial after 5.2 years, concluding that the risks for the study group on combined HRT outweighed the benefits. 

  Risks included small but significant increased risks of breast cancer, coronary heart disease, stroke, and blood clots for the group of women on HRT. Only 2.5 percent of women in the estrogen plus progestin study had these health events.

  These results tell us that during one year, for every 10,000 women taking estrogen plus progestin, we would expect:

• Seven more women with heart attacks. In other words, 37 women taking estrogen plus progestin would have heart attacks compared to 30 women taking placebo.
• Eight more women with strokes.
• Eight more women with breast cancer.
• 18 more women with blood clots.

Benefits of HRT use included lower risks of hip fractures and colon cancer. These results also suggest that for every 10,000 women taking estrogen plus progestin, we would expect:

• Six fewer colorectal cancers.
• Five fewer hip fractures.
• Fewer fractures in other bones.

  This decision should be made by you and your physician. The first thing you must do is determine the risks and benefits of continuing therapy.

Some good questions to ask include:

• Does the estrogen and progestin successfully treat your menopausal symptoms successfully?
• Do you have a history of osteoporosis?
• Is there a history of breast cancer in your family?
• Have you had any clotting disorders?
• Do you have a history of heart disease?

  Make a list of pros and cons and go over them with your physician. The decision also depends on how long you have been on HRT. For example, most cardiac events occurred during the first two years of starting therapy. On the other hand, the study suggested breast cancer risk is cumulative and rises over time. But Dr. Murrmann points out that a womans risk of breast cancer increases with age.

  First, you should not stop HRT cold turkey. Work with your physician to wean off the drugs and see how you feel without taking the hormones.

  Heart disease in women escalates after women reach their 50s. Because estrogen levels drop during this time, people assumed that when estrogen drops, the risk of heart disease increases. It is also known that estrogen can increase levels good blood cholesterol (HDL) and decrease bad cholesterol (LDL). The WHI study indicates HRT doesnt have a positive effect in heart disease.

  It can never be one drug alone, Murrmann said. Youve got to exercise. Youve got to change your diet. Youve got to have regular checkups. With this nation becoming more obese by the minute, heart disease is going to be on the rise no matter what. 

  If you experience symptoms, there are other medications that can treat symptoms. Some anti-depression medications have had success with hot flashes. Some women report success with alternative medicines such as soy and black cohosh. 

  It is not recommended, since it is known that women with a uterus who take only estrogen are at greater risk for endometrial cancer.

  This study did not include birth control pills. There has never been any conclusive evidence regarding birth control and heart disease.

  This article is not a substitute for medical advice from your physician. If you have questions and concerns about HRT, please consult your doctor.