Making Sense of Hormone Replacement Therapy

July 11

Doctors around the country are reporting that patients who take hormone replacement therapy are scared, confused and in some cases panicking after this week's announcement that a study of hormone replacement therapy was stopped because of increased risks of cancer and heart disease.

The trial, called the Women's Health Initiative, has found that the combination hormone treatment of estrogen plus progestin significantly increases a woman's risk of invasive breast cancer, stroke, heart disease, and blood clots in the legs and lungs. Moreover, the hormone combination does not reduce the risk of heart disease, as was previously believed.

However, it is important to note that these results apply only to the combination of estrogen and progestin treatment in women who still have their uteruses, and do not indicate that all hormone medications lead to cancer, stroke, and heart disease.

Women who have had their uteruses removed by hysterectomy are usually treated with only one hormone, estrogen.

A separate ongoing study is examining estrogen-only therapy in more than 10,000 women without a uterus, and while these results are not yet available, the investigators do know at this time there is no increase in breast cancer.

Unnecessary Alarm?

Some doctors are blaming poor reporting by the press for creating the alarm, but others say the reason for the confusion was the simple fact that doctors learned of the results of the study at the same time as patients, and did not have enough information to answer questions.

Dr. Sharonne Hays, director of the Women's Heart Clinic at the Mayo Clinic, said this left many physicians feeling "hung out to dry" when they could not answer patient questions.

Reaction has ranged from simple questions, to demands for immediate action. "A lot of patients are asking for a hysterectomy now so they can quit their progesterone," said Dr. Louann Brizendine, director of the Women's Mood and Hormone Clinic at the University of California, San Francisco.

"It's a circus here. Women are panicked," said Dr. Michelle Warren, director of the Women's Health Center at Columbia Presbyterian Hospital in New York. Warren said women do not understand "the risk is small and does not apply to hysterectomized women, women on estrogen alone."

To help women interpret this news and answer their questions, Dr. Hayes and others at The Mayo Clinic have prepared answers to the most common questions doctors are receiving on this issue:

Should I stop taking hormone replacement therapy today?

No, these findings are not an indication that you should stop immediately. You should discuss with your doctor what's best for you at your next health care visit.

— Mayo Clinic

Should I set up an appointment today?

It is not urgent, but important to address at your next visit. While the study has important public health implications, the risk of taking this particular type of hormone therapy, specifically oral conjugated equine estrogens with oral medroxyprogestrone acetate (CEE/MPA or Prempro) for an individual woman over a short term (Mayo Clinic

What is the long-term risk?