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Hormone users take the chance

A major study prompted many menopausal women to toss their estrogen pills, but for some, the quality of life with the drugs far outweighs the benefits of quitting.

March 31, 2003|Shari Roan | Times Staff Writer

After hearing last summer that hormone replacement therapy may do more harm than good, Donna Hayden tossed her supply of estrogen and progestin. That was the easy part.

Within five days, the 56-year-old Costa Mesa woman developed hot flashes. Soon after, she began losing sleep and having trouble concentrating. Six weeks later, Hayden was on her way to the pharmacy to pick up a new supply of pills.

"I felt like a junkie," she said. "But I had to go back on them."

Like Hayden, thousands of women across the nation stopped taking hormones based on results from the massive Women's Health Initiative study. In the first wave of media reports, researchers announced in July that taking estrogen and progestin for several years slightly increases a woman's risk of heart attack, stroke and breast cancer. This month, investigators reported that post-menopausal women taking hormones had no improvements in cognition, depression, insomnia or sexual function compared to women who did not take hormones.

Now, the subsequent experiences of women who went cold turkey have driven home a key point -- for some individuals, hormone therapy may be worth the risk. An estimated 10% to 20% of menopausal women are tormented by severe symptoms, particularly hot flashes, and alternatives to hormones often prove inadequate. For them, life without hormones can be miserable.

"We hear from women who have these severe, flaming hot flashes who can't get through the day the way they need to," said Cynthia Pearson, executive director of the National Women's Health Network, a consumer advocacy organization in Washington, D.C. "Hormone replacement therapy is the only real alternative."

The complaints have also uncovered what may be a new medical syndrome, one in which estrogen withdrawal actually causes hot flashes. The possible connection, some physicians say, may shed light on how and why hot flashes occur naturally in menopause. Not only do doctors know little about what causes hot flashes, they don't understand why some women have them and some don't, nor why some cases are severe and others mild.

Serious hot flashes can cause drenching night sweats that require women to change clothing and sheets several times during the night, leaving them exhausted the next day. The daytime bursts of body heat embarrass many women and disrupt their work.

While doctors no longer advocate hormone replacement therapy for almost all menopausal women, many say they believe that a few years of hormone use in younger menopausal women with serious symptoms carries little risk. Some advise women to use hormones for severe hot flashes or to return to hormones temporarily and then taper off slowly instead of stopping them abruptly.

"I think women are being overly frightened, almost intimidated, by data that doesn't quite justify the level of fear," said Dr. Wulf Utian, executive director of the North American Menopause Society, an organization of menopause specialists. "For the younger, peri-menopausal or early menopausal women, who are most likely to have severe hot flashes, the level of risk is much less."

The Women's Health Initiative, a 15-year study headed by the federal government, was designed to explore the major causes of death, disability and frailty in post-menopausal women and how to prevent health problems linked to aging. It found that older women taking estrogen and progestin for five years have a 1-in-100 chance of suffering a serious side effect, such as a heart attack, from hormone use. But 50-year-old women probably have only a 1-in-1,000 chance of having such a side effect after one year of hormone use.

The study, so far, has reported on women who take estrogen and progestin -- the latter to guard against the development of uterine cancer. Another arm of the study, still ongoing, will explore the risks and benefits of taking estrogen alone among women who have had hysterectomies.Based on the current data, study leaders say that women should not take hormones if they don't have menopausal symptoms, that those who do have symptoms should consider alternatives to hormones and that women who choose to take hormones should take the lowest possible doses for the shortest possible time.

Still, it may not be easy for some women with severe menopausal symptoms to limit hormone use to a year or two. Doctors can't predict how long hot flashes and other symptoms will persist, says Utian. Nor can they predict the length or likelihood of estrogen-withdrawal hot flashes.

"I've seen 70- and 80-year-old women still having hot flashes," Utian says. "Women go on hormones, and they are extremely effective. And when they stop, a large number have a recurrence of hot flashes. They go on the medication with every good intention of using it short term and it becomes long term."

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