MDs give OK to hormone therapy
Reported January 23, 2009
With unprecedented numbers of Canadian women about to enter menopause, Canadian doctors are telling women it’s safe to go back on hormones.
An expert panel convened by the Society of Obstetricians and Gynecologists of Canada has concluded that no treatment is as effective as hormone therapy for hot flashes and other symptoms of menopause.
The group says an “extensive” review of new data — along with a re-analysis of a massive study that led women to abandon hormones in droves seven years ago — shows hormones are a safe option for moderate to severe symptoms, if started early and used over the short term.
The group is recommending using the lowest effective dose. And while there is no fixed timeline, they suggest taking it for “four to five years is a good starting point,” said Dr. Robert Reid, lead author of the updated guidelines and chairman of the division of reproductive endocrinology and infertility at Queen’s University.
“A lot of women were told point-blank, ‘Stop your hormones. Suck it up.’ And they’re in my office with terrible hot flashes and irritability and depression and other mood things, and they’re saying, ‘My doctor won’t prescribe (hormones) for me,’ ” Dr. Reid said. “What we’re trying to do is ensure people who have symptoms that may benefit aren’t afraid to put (hormones) on the list of options.”
This year, the largest demographic from the Baby Boomer generation turns 50. In Canada, there are now 2.5 million women between 45 and 54.
Women are expecting treatments will be provided to them, Dr. Reid said.
Women and their doctors were frightened off hormones after a run of troubling news from one of the largest and most expensive studies ever conducted by the U.S. National Institutes of Health.
The Women’s Health Initiative Trial, which involved nearly 17,000 women, was prematurely halted in 2002 after researchers discovered an increased risk of heart disease, strokes, breast cancer and blood clots in women using an estrogen-progestin combination.
In Canada, hormone prescriptions plummeted, from 11.6 million in 2002 to five million in 2007, and down further to 4.8 million in 2008, according to IMS Health Canada, a firm that tracks prescription-drug use.
Many doctors told women to go off hormones and to try losing weight. They were advised to use fans or cold face cloths for hot flashes. The hormone backlash helped fuel a multi-billion-dollar market for alternative products, with scant safety data or evidence of benefit, doctors say.
But a second look at the data found no increases in risk for coronary heart disease in younger women aged 50 to 59.
Dr. Michel Fortier, professor of obstetrics and gynecology at the University of Laval, said the No. 1 fear of using hormones is breast cancer. But, he says, “women take a much greater risk by getting into a car to (drive to) my office than taking HT (hormone therapy).”
The Canadian update says longer-term use (more than five years) increases the risk of breast cancer, but the risk is similar to the risk a woman runs by being overweight, drinking alcohol every day or not exercising.
The risk returns to normal after hormones are stopped.
Dr. Reid said herbal and natural health products can interact with prescription drugs and anesthetics.
“We are now telling our members not to be sending a woman to the drugstore to find a herbal remedy for her hot flashes,” Dr. Reid said.