hi all

i figure if i managed to get through puberty
with no pharmaceutical assistance
i can handle menopause too

being female is not a chronic medical condition

admitting yesterday's error means admitting
that we are wiser today than we were yesterday

janet

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Scientists Question Hormone Therapies for Menopause Ills

April 18, 2002 - A new report by a panel of international experts casts
doubt on longstanding claims that hormone replacement can prevent or treat
a variety of ills in postmenopausal women, including heart disease,
Alzheimer's disease, severe depression, urinary incontinence and broken
bones caused by osteoporosis.

While hormone therapy is the most effective way to relieve menopausal
symptoms like hot flashes and night sweats, there is not enough scientific
evidence to support its use for the other problems, says the report, which
is to be published in June.

The hormone treatments have well-documented drawbacks, including an
increased risk of blood clots and gall bladder disease and breast cancer
with prolonged use.

More than 40 million American women are 50 or older, and 20 million more
will reach menopause within the next decade.

About 20 percent of women who reach menopause naturally use hormone
replacement at least temporarily, according to the North American Menopause
Society.

The figure is higher among women who reach menopause early because their
ovaries have been surgically removed.

Hormone replacement usually consists of estrogen with another hormone,
progestin, or — for women who have had hysterectomies — estrogen alone.

Given the known risks and limited benefits of hormone treatments, the
report says, each woman and her doctor should weigh her medical history
carefully when deciding whether she really needs it.

Drugs to lower cholesterol and blood pressure are a better way to cut the
risk of heart disease for many women, and other nonhormonal drugs may be a
better way to prevent fractures.

That advice is a departure from decades of medical practice in which many
women and their doctors assumed that taking estrogen at menopause was a way
to preserve youth and health.

American women spent $2.75 billion on hormone replacement in 2001,
according to IMS Health, a company that tracks drug sales.

Premarin, a form of estrogen replacement therapy sold by Wyeth, was the 3rd
most commonly prescribed drug in the United States last year, with more
than 45 million prescriptions dispensed.

The new report, called the International Position Paper on Women's Health
and Menopause, was financed by the National Institutes of Health and the
private Giovanni Loren Zini Medical Science Foundation of Italy.

It reviews existing studies and was compiled by 28 doctors and scientists
from the United States, Italy, Sweden, Switzerland and Australia.

Dr. Nanette K. Wenger, chief of cardiology at Grady Memorial Hospital in
Atlanta, who was an editor of the report and chairwoman of the panel that
prepared it, said the report tried to put up-to-date information into one
publication that doctors all over the world could use.

The report's cautious approach to hormones is based on the findings of
recent studies and on its authors' decision to emphasize "evidence-based
medicine" — that is, treatments tested in randomized controlled trials.

Such trials, in which patients are assigned at random to either a treatment
or a placebo, are considered the gold standard in medical research.

By contrast, observational studies, in which patients themselves decide
whether to take a drug, are considered less reliable.

Observational studies have suggested many health benefits from hormone
replacement, but more recent controlled trials have disagreed.

Researchers say the observational studies may have painted a falsely rosy
picture of hormone replacement because women who opt for the treatments are
healthier and have better habits to begin with than women who do not.

The full report is to be issued in June by the National Heart, Lung and
Blood Institute, but a chapter on hormone replacement and other treatments
was distributed at a symposium last month at the National Institutes of
Health.

Researchers who worked on the report said some of its findings might shock
doctors and patients.

Dr. Vivian W. Pinn, director of the institutes' office of research on
women's health and another editor of the report, said that many people,
including physicians, had believed that hormone replacement would prevent
heart disease and strokes and help women live longer.

But, Dr. Pinn said, "as we're learning more from long-term studies and
better defined studies over the past few years, all these things we've
thought about the wonders of hormone replacement may not be holding up
under scrutiny."

Dr. Wenger added: "Given the fact that hormone replacement has been around
for 50 years, it's really only in the last 10 years that we've begun to get
stringent scientific evidence, from randomized controlled trials.

"In many areas there have been enormous surprises."

For instance, Dr. Wenger said, three recent controlled trials have found
that, rather than protecting women from heart attacks and strokes, hormone
replacement increased their risk.

One trial in women who already had heart disease showed no benefit from 4
years of hormone treatment and a 50 percent increase in the risk of heart
attack in the first year of treatment.

Another study, which includes more than 27,000 women, most without heart
disease at the start of the trial, found a slight increase after 3 years in
heart attacks, strokes and blood clots in the lungs in women taking
hormones. That study will not be completed until 2006.

A 3rd study found no benefit to hormone treatment after 2.8 years, and more
than 2 times the risk of stroke in the first 6 months.

Last year, the American Heart Association warned that women should not
regard hormone replacement as a means of treating or preventing heart disease.

Even though hormones can help lower LDL cholesterol — the "bad" kind of
cholesterol — and raise HDL cholesterol — the "good" kind — the group said
that statin drugs were a far better way to do so.

Hormone replacement can prevent bone loss from osteoporosis, and
observational studies have suggested that it reduces the risk of fractures.

But bone loss resumes once a woman stops taking hormones.

Moreover, no large randomized controlled trials have been conducted to
determine whether the treatment reduces fractures.

The Food and Drug Administration has approved hormone therapy to prevent
osteoporosis, but not to treat it.

Another group of drugs called bisphosphonates prevent bone loss about as
well as estrogen, and have been proved to cut the risk of fractures by 40
percent to 50 percent in women with osteoporosis.

Dr. Wenger said that doctors had long assumed that hormone replacement
would help older women who suffered from urinary incontinence.

"But now two trials show no improvement, and there may be a worsening," she
said.

The reports notes that many doctors thought estrogen would prevent memory
loss and slow the progression of Alzheimer's disease.

But clinical trials have shown no benefit in early Alzheimer's disease.

Studies on memory loss are still being done.

Similarly, there is no evidence that hormones can treat severe depression
in postmenopausal women.

But the report notes that hormones may improve "mood and well-being" in
women who suffer from hot flashes and night sweats that disturb their sleep.

"So many of the earlier presumptions, as they come to trial, do not show
evidence of benefit," Dr. Wenger said.

Dr. Deborah Grady, a professor of epidemiology and medicine at the
University of California at San Francisco, was lead author of the 1992
guidelines on hormone replacement for the American College of Physicians.

At that time, she said, "I thought preventive hormone therapy
shouldprobably be prescribed to most postmenopausal women, except those at
high risk for breast cancer," and incorporated that view into the guidelines.

Today, Dr. Grady said, "rather than prescribing it for most postmenopausal
women, I prescribe it for symptoms, for which it is far and away the best
treatment."

In many women, she said, hot flashes diminish after 3 to 6 months even
without treatment, though they may not end for 4 to 5 years.

"I spend a lot of my life now trying to figure out how to help women taper
off estrogen," Dr. Grady said.

Dr. Wenger said that, in contrast to the year 1900, when few women survived
much past menopause, women today in developed countries live 33 per cent of
their lives after menopause.

"We must require that medical management be based on the same stringent
scientific evidence that we've always required for the treatment of men,"
she said.

By Denise Grady
Copyright 2002 The New York Times Company
http://www.nytimes.com/2002/04/18/health/18HORM.html

(the above has been edited for consistency of numerical format
i.e. all numbers shown as words have been converted to numerals - jmp)

janet paterson: an akinetic rigid subtype, albeit perky, parky
pd: 55/41/37 cd: 55/44/43 tel: 613 256 8340 email: [log in to unmask]
smail: 375 Country Street, Almonte, Ontario, Canada, K0A 1A0
a new voice: http://www.geocities.com/janet313/

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