Women's Health

A Primer on Menopause What Every Woman Should Know. Part 4

Taking hormones for a few years and then gradually tapering off is probably fine, said Love. The more complex question is whether adding hormones for long-term use during perimenopause and beyond can help prevent problems like heart disease and osteoporosis.

“A lot of the controversy springs from the fact that we haven’t actually proven most of the claims for adding hormones,” said Love. Further, studies have shown that by adding hormones a woman is increasing her chances of getting cancer, especially of the breast, and of getting blood clots.

Why take something that could give you cancer, asks Seaman, the co-founder of the National Women’s Health Network, a member-supported organization that is a longtime advocate for women’s health. Based on her studies of problems associated with hormone use since the 1940s, she calls their inclusion other than on a short-term basis “unjustified.”

For his part, Thomas, in his practice as a reproductive endocrinologist, said, “I do see the benefits of hormone replacement therapy,” including for prevention of the problems of heart disease and osteoporosis.

What women need to make a decision, he said, is copious amounts of information and a balanced discussion of the pros and cons. He is currently working on a consensus paper that identifies whether women who are members of minority groups are getting adequate information on the use of hormones.

Thomas said about a quarter of the women in menopause are taking hormone replacement medication. About 50 percent of women who start hormones stop taking them within a year. Of those that continue, about two-thirds are women who are seeking estrogen because they no longer have ovaries that are producing any estrogen at all.

Lifestyle Changes
It’s important to stress that it’s never too late to begin making lifestyle changes to prevent serious medical conditions like heart disease and osteoporosis, said Marks, including the following:

Do not smoke.

Eat well: healthy foods and sufficient calcium intake.

Exercise: Walk, move your body.

Take care of your spirit: Reduce stress and do things you enjoy.

Alternative Treatments
Some of the areas in which women have chosen alternative methods include vitamin and mineral supplements, herbs and acupuncture.

The public is increasingly combining conventional medical treatments with alternative or complementary therapies, said Mark. She has formed a task force of federal agencies to look at this issue, specifically through CAMPS, a comprehensive study to assess what women 45 and older are thinking and doing in regard to menopause. The data that’s been gathered is now in the process of being analyzed.

“I think it’s important that we study not only the efficacy, but the safety,” Mark said. Over the past year, the NIH has created the National Center for Complementary and Alternative Medicine, and it is expected that high-quality studies will be generated on how good and how safe alternative techniques are for menopause as well as other conditions.

For now, she said, there is not enough information available to know about interaction between alternative and conventional therapies.

Evaluating the Options
As new research comes out on any of the issues of menopause, Mark said, one study may refute another, thanks to better design or other variables. “It’s an evolving process,” she said, and women need to understand the information generated in light of who they are as individuals.

One study that it is hoped will provide guidance is a large, randomized, controlled study undertaken by the Women’s Health Initiative to look at hormone replacement therapy and heart disease, osteoporosis and Alzheimer’s disease, said Love. However, it will not be completed until 2008.

In the meantime, women and the medical profession have a number of studies on hormone therapies, many of which seem to have conflicting information. One of the problems is that many of the studies, to date, have been based on observational data rather than randomized, controlled data, the methodology that guides the medical profession to identifying the gold standard in treatment.

One recent study published in the January 2000 issue of JAMA, The Journal of the American Medical Association, looked at more than 46,000 post-menopausal women. It compared the rates of breast cancer between those who took estrogen alone in hormone replacement and those who took estrogen plus progestin. Progestin had been added to the hormone mix several years ago in order to protect the uterus from the cancer-causing properties of estrogen.

One promising area of research is the use of SERMs, selective estrogen receptor modulators, or hormones that interact with specific parts of the body without having the potential of negative effects on other parts.

Love said the key to grasping what is best to consider doing in menopause and beyond is to understand, “This is a work in progress. We are finally doing studies that answer the questions.”

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