In a news release on March
2, 2004, NIH advised that women taking estrogen alone
could be at
risk for stoke
and possibly at risk for dementia. They are encouraging women
to consult their health care provider and determine if they
are at risk for osteoporosis—the only risk apparently
reducible by taking estrogen—sometimes marketed as
Premarin™. NIH found that "although hormone therapy
is effective for the prevention of postmenopausal osteoporosis,
therapy should only be considered for women at significant
risk of osteoporosis who cannot take non-estrogen medications." The
Food and Drug Administration also recommends that estrogen
and progestin should always be used at the lowest doses for
the shortest duration needed to achieve treatment goals.
NIH has notified the 11,000 women enrolled in the current
study to stop taking the estrogen, essentially determining
that estrogen alone would have some overarching usefulness
that the hormone combination (estrogen and progestin) did not.
In canceling the study NIH indicated—"The NIH believes
that an increased risk of stroke is not acceptable in healthy
women in a research study. This is especially true if estrogen
alone does not affect (either increase or decrease) heart disease,
as appears to be the case in the current study."
In summary, the NIH study found that:
- Estrogen alone increased the risk of a stroke
as much as estrogen-progestin
does. For every 10,000 women, those taking estrogen suffer
eight more
strokes per year than those who took the placebo.
- Estrogen
alone had no effect, good or bad, on heart disease.
- Estrogen
alone does not increase or decrease the risk of breast cancer.
- Preliminary
data from a related study of women 65 and older suggest those
taking estrogen were more likely to suffer some degree of
dementia than
those taking a placebo.
- Estrogen is thought to decrease
the risk of a hip fracture from bone-thinning
osteoporosis.
The full report on the findings of this
study is to be released in two months.
Millions of women who have had a hysterectomy or are post
menopausal are currently taking estrogen. If you are one of
them, in
light of this new information, what should you do?
- Call your health care provider and ask for an appointment
to evaluate your particular health risks. In assessing your
risks it is important to determine what benefits (beyond
relief of uncomfortable feelings like hot flashes, vaginal
dryness and irritability)
you are receiving from the estrogen. Since the only undisputed
benefit—based on the NIH research—is decreasing
the risk of osteoporosis, you will want to be certain to
address your need to reduce this specific risk. This would
be indicated
by a positive family history and your body type—thin
Anglo-Saxon women with small bones/frames are at higher risk.
- Read and if you think it may be helpful, print the
important information from the NIH
site and
take it with
you when you go to see your health care provider.
- Remember that many women have found that post-menopausal
discomfort can be reduced by exercise, getting sufficient—approximately
eight
hours—sleep, stopping smoking, drinking alcohol
only in moderation and eating a diet high in fiber, low
in fat
and
refined sugars. Fortunately these practices do also serve
to decrease the risks for heart disease, stroke, cancer and
diabetes.
This is a win-win.
- Plant estrogen is an available alternative (as a dietary
supplement) to the forms currently prescribed and for many
women, seems to provide symptomatic relief of post-menopausal
symptoms. However, since supplements are sold as dietary
rather than drugs, they are not regulated as drugs and not
studied
in the same way. Thus, whether or not plant estrogen
would have the same risks and as synthetic estrogen is not
known.
The following site gives excellent information on this
topic. www.acog.com/from_home/publications/misc/pb028.htm.
A relatively new medication is thought to "fool" your
body—your estrogen receptors—into thinking
your body is getting estrogen. Your health care provider might
be willing to provide you information on this alternative.
To read and learn more about HRT go to:
/healthinfo/hrt.htm
For more detailed information on the NIH Estrogen Study go
to:
www.nhlbi.nih.gov/whi/index.html#estrogen |
