Quitting HRT

Couple of weeks ago, we published a column on hormone replacement therapy (HRT). The column reported on Women’s Health Initiative (WHI) trial. The trial was suddenly stopped because it was found that HRT (estrogen and progestin) in post-menopausal women was responsible for:

-41 percent increase in stroke
-29 percent increase in heart attacks
-doubling of rates of blood clots in the legs and lungs
-26 percent increase in breast cancer
-22 percent increase in total cardiovascular disease.

But, it also said that HRT has benefits:

-37 percent reduction in cases of colorectal cancer
-33 percent reduction in hip fractures
-no difference in total death rate from all causes
-controls hot flashes

After reading that column, a lady wrote:

“I have been on HRT for around eight to 10 years, and after reading your column in the paper, I totally stopped using the HRT.”

This lady was scared that now she is off HRT she will get “emotional problems” and she had started to get hot flashes. She was worried because she could not get to see her doctor for three weeks!

My advice in the column was simple – DO NOT STOP TAKING HRT WITHOUT DISCUSSING FIRST WITH YOUR FAMILY PHYSICIAN OR GYNECOLOGIST. If one is on HRT for 10 years then waiting three weeks to see a doctor is not going to make anything worse.

I was also told by Dr. Robert Woolf that women who need HRT should look into natural hormone replacement therapy. Woolf is a family physician in Medicine Hat who also practices alternative or complementary medicine. The natural hormones are derived from plants.

What is the safety and efficacy of the natural hormones over a long period of time? NEWSEEK reports that the National Institutes of Health is now supporting a trial to test two herbs for post-menopausal symptoms. So far, researchers have found no side effects, but they will continue to monitor women for changes in the breast, uterus and bones. Results will be keenly awaited.

What should post-menopausal women do now?

Last week, the Canadian Society of Obstetricians and Gynecologists (SOGC) released guidelines for HRT use in response to WHI trial. Here are the main points:

-If you have been on HRT for more than five years then talk to your physician whether you should continue
-Do not be overly concerned if you have been on HRT for more than five years – danger to an individual woman is small
-If you need to be on HRT then take the lowest possible dose for the shortest possible time – probably not longer than four years
-97.5 per cent of women, out of 8000 in the WHI study, had no adverse outcomes
-If you have been off HRT for five years then the risk of cancer drops to zero
-These guidelines apply to women who are on combination therapy of estrogen and progestin.

If you are on HRT then there is no need to panic. Discuss your options with your family doctor or gynecologist. There is more than one way to stay healthy and happy.

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