Subject:
Combination Hormone Replacement Therapy
To: The Patients of Dr.'s Simon and Grade and Mary
Meyer, RN, CWHNP
From: Dr. Simon, Dr. Grade and Mary Meyer
As many of
you are aware, a recent triail sponsored by the National
Institutes of Health to examine the risks and benefits
associated with combination hormone replacement (HRT)
(estrogen and progesterone) on women's health was
published. The study was stopped after 5.2 years due
to an increase in risks demonstrated in women using
combination HRT versus those on placebo. An increased
risk of breast cancer, coronary events / heart attacks,
stroke and blood clots in the lungs was seen. A
decreased risk of hip fractures and colon cancers was also
shown in users of HRT versus non-users. The study
involved over 16,000 women aged 50-79 who were healthy and
begun on HRT or not (Placebo).
This study
only examined the use of conjugated estrogen (Premarin) with
medroxyprojesterone (Provera) - other forms of HRT were not
looked at and we cannot definitely say that the same effects
seen in this study would be seen in women on other forms of
HRT. In addition, these same risks were not seen in
women only on estrogen without progesterone. (Only
women without a uterus should be on estrogen alone.)
We must keep
in mind that although the study showed statistically
significant increases in these risk factors, the actual
numbers of events were small as follows.
For every
10,000 women using HRT versus those not using HRT, we will
see 8 more cases of breast cancer, 7 more coronary events,
8 more strokes and 8 more blood clots in the lung after 5
years of use. We would also see 6 less colorectal
cancers and 5 fewer fractures by this data.
The study
did not address HRT use to prevent menopausal symptoms, ie.
hot flashes, mood swings and other symptoms of the
climacteric over the short term (less than 4 years).
Short term therapy for this purpose we feel does not place a
patient at increased risk.
The American
College of Obstetrics and Gynecology and the NIH agree that
we should reassure our patients that the results of this
study are most important in addressing the risks of an
entire population of women and not to an individual woman
whose personal risk of these factors is less than 1/10th
of 1% per year.
We feel that
women should therefore not become unduly alarmed by this
information but rather take into consideration her
individual risk factors for heart disease, breast cancer,
osteoporosis, and colon cancer. Use of HRT is an
individual's choice however, and if you are concerned about
this information, then it is your choice to discontinue your
HRT.
More
information is available through the NIH web sites:
At this
point we do not recommend abrupt discontinuation of HRT.
Other problems may emerge like hot flashes, mood swings, or
vaginal atrophy / skin changes. We have provided
this information to address our patient's concerns. If after
reading this information you feel you have more questions,
please make an appointment with Dr. Simon, Dr. Grade or Mary
Meyer to address your personal concerns.
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