by Marcelle Pick, OB/GYN NP
Some time has passed since the publication of the first of the Women’s Health Initiative studies on the risks of HRT, and newer studies regularly appear, all adding to the impression that synthetic HRT is dangerous to your health. This seems a good time to put some perspective on the findings that caused such concern and confusion — among women as well as among their health care providers.
There is no loss of urgency on the issue. Over 13 million women were on some form of HRT before the initial studies were published. Millions quit “cold turkey” and saw their symptoms rebound. Millions stayed on HRT but live in fear of the consequences and hormone replacement therapy side effects. And millions of women have been moved onto antidepressants as pharmaceutical companies have campaigned to position those drugs as substitute products — even though most of these women are not depressed and are thereby exposed to a new set of potential side effects.
While we agree that women should consider alternatives to synthetic HRT, most of the fear and confusion is unnecessary. Let’s start with the point of view that in light of the studies, all HRT is bad and no one should use it.
Before the WHI study, about 8 million women who had had hysterectomies were on estrogen replacement therapy, and another 6 million were on a combination of estrogen and progesterone, as recommended by their practitioners. The great majority of these women were on either Prempro or some other combination of Premarin, and because Prempro was the drug used in the WHI study, it’s understandable that so many felt some combination of fear and panic.
First, note that the studies published to date all concern synthetic HRT, specifically Premarin and Prempro. They say nothing about bio-identical hormone replacement therapy. Second, the women in the WHI studies were on HRT after menopause, which is most often unnecessary therapeutically and obviously unnatural. The most common therapeutic use of HRT is for perimenopausal symptoms. So we can’t say the WHI studies really predict the health risks for women in their 40’s who are the typical users of synthetic HRT. Third, there clearly are women who want HRT — even synthetic HRT. We believe they are entitled to make that choice for themselves.
Now let’s turn to the other point of view — those that say HRT should still be considered safe because the absolute risks are small, and, as they claim, there’s no good alternative.
First, consider that there is a mountain of evidence indicting synthetic HRT. Alternative practitioners have recognized the problems with synthetic HRT for many years. There are dozens of studies documenting its adverse health risks. In fact, it’s disappointing that it has taken a massive government program like the Women’s Health Initiative to change the standard of care.
Second, while the higher risks are small in absolute terms, the increases in relative risk are significant. To take heart attack as one example, the study means that out of 10,000 women on Prempro, an extra 6 would have a heart attack each year compared to women not on Prempro. That may not seem like a substantial risk. But it is a much greater relative risk.
A new study at Penn State (June 2005) found that levels of CRP are increased with intake of HRT and oral estrogen. CRP is a pro-inflammatory blood protein associated with increased risk of heart attack and stroke.