ORIGINALLY WRITTEN ALEEN RATZLAFF
Recent national media reports of increased risks associated with hormone treatment therapy for postmenopausal women has had local women expressing concerns about that treatment strategy.
“We’ve been impressed with the number of women calling,” said physician Randy Whitely of PMA Hillsboro Family Practice Clinic. “I’ve probably had seven or eight (calls from patients).
“For each one call you get, though, there’s probably two people who haven’t called.”
The calls to Whitely are in response to a recent article in the Journal of the American Medical Association that reported about a five-year study of hormone use by postmenopausal women ranging in age from 50 to 79.
The study, which was testing women who used combined estrogen and progestin, was stopped early because health risks exceeded health benefits.
“Out of 10,000 women on Prempro, 38 women had heart attacks whereas out of 10,000 women on placebos, 30 had heart attacks-a difference of eight,” Whitely said.
“But if you plug those numbers into a statistical analysis equation, apparently that is a statistically significant difference. That’s why the study has become controversial and led to a lot of folks wondering whether Prempro is safe.”
Prempro is a brand name for combined estrogen and progestin, said pharmacist Lou Greenhaw of Greenhaw Pharmacy in Hillsboro.
Since the first of the year, Greenhaw Pharmacy has been filling about about 100 prescriptions per month of Premarin, which covers hormone replacements that include both the combination and single estrogen products.
“Some women have stopped taking the combination hormone replacement,” Greenhaw said.
Many physicians have prescribed estrogen combined with progestin because they believed it enhanced health benefits for postmenopausal women, such as reducing incidence of heart disease, breast and colorectal cancer and fractures.
“(It was believed) that estrogen was one of the reasons why women lived longer than men in that it slows down the rate of atherosclerosis,” Whitely said.
Atherosclerosis refers to the progressive buildup of fatty deposits on the inner walls of the coronary arteries and is often referred to as hardening of the arteries.
Response from physicians to the JAMA study has varied.
“I’m hearing a lot of doctors saying they’re going to continue to prescribe Prempro,” Whitely said. “It’s really basically a case-by-case basis. If a woman has a family history of heart attacks at a young age, or blood clots or breast cancer or uterine cancer, then they really need to talk to their doctor about safety versus the benefits of Prempro.”
Since the findings of the study were reported, Whitely has made adjustments in the dosage he prescribes for his patients.
“One of the take-home points of that article was if you put a woman on Prempro, or if she’s taking it primarily to prolong her life and prevent heart attack, then that actually has been proved to be the wrong thing to do,” Whitely said.
“One compromise that I’ve reached with folks is I tell them to take half of their previous dose. Then if they have any of those positive family history, we talk. If the family history is significant-heart attack less then age 60, breast cancer less than age 60, blood clots or uterine cancer-then they probably need to not be on Prempro.”
Some women may consider alternatives to hormonal treatment therapy. Whitely said Evista, a pharmaceutical product, is one option.
“Evista actually can cause hot flashes, though,” he said. “It’s not quite as good as estrogen in protecting the bones.”
Whitely said he does not know much about herbal therapies as an alternative for hormone replacement therapy.
“Unfortunately, they don’t teach us a lot about that in medical school,” he said. “From my standpoint, I have to tell my patients they’re basically on their own (if they choose that approach). There are some books out there and some doctors are more well-versed in that than I am.”
Whitely said the findings in the JAMA article focus only on the combination of estrogen and progestin, but he anticipates other articles will be published about health benefits and risks of hormone replacement therapy.
In the meantime, Whitely passed on advice he gives women who use an estrogen supplement.
“They absolutely have to be doing monthly self breast exam and getting the annual physical,” Whitely said. “The monthly self breast exam is widely underdone. If they’re going to be on the estrogen supplement, they need to be doing those.”
