Over six million, or 38% of American women experiencing menopause, and taking hormone replacement therapy (HRT), were recently asked by their healthcare providers to stop taking this drug. With over 70 million prescriptions written every year, HRT was once a drug of choice to relieve symptoms and discomforts of menopause. HRT was also once believed to prevent heart disease, stroke, and osteoporosis. However, the National Heart, Lung and Blood Institute (NHLBI), the National Cancer Institute (NCI) and the US Centers for Disease Control (CDC) recently reported about a study revealing that women experiencing menopause and taking HRT were more likely to develop heart disease and breast cancer, than women experiencing menopause who were not taking HRT. In a question and answer format, this articles discuses menopause, HRT, why the use of HRT was recently stopped, and identifies other ways to relieve the symptoms of menopause.

What is menopause? Menopause is the point in a woman’s life when menstruation permanently stops, and signals the end of her ability to have children. Physiologically, this is the last stage of a gradual process in which reproductive glands in the woman called ovaries reduce their production of female sex hormones, mainly estrogen and progesterone. A reduction in the production of female sex hormones called peri-menopause begins about 3 to 5 years before the final menstrual period. Menopause is considered complete when a woman has been without menstrual periods for one year.

What is hormone replacement therapy (HRT) and Estrogen replacement therapy (ERT)? HRT is a combination prescription drug containing estrogen and progesterone, used to replace the hormones that the ovaries in the woman’s body stops making at the time of menopause. Estrogen Replacement Therapy (ERT) is also a hormone replacement prescription drug which contains only one of the female sex hormone called estrogen. Because of the known side effects and complications of ERT on the endometrium (inner lining of the uterus), ERT is mostly prescribed only to women who have had a hysterectomy (surgical removal of the uterus).

Why do women experiencing Menopause have to take HRT or ERT?

These drugs are prescribed to relieve common symptoms and discomfort of menopause which include hot flashes, sleep disturbance, vaginal dryness, mood swings, and urinary disturbances.

Why has the use of HRT been recently stopped? The use of HRT has been stopped because of increased health problems associated with taking the drug. A recent study which involved over 16,000 menopausal women taking HRT (the combination of estrogen and progestin) revealed an increase in the risk for having heart disease, breast cancer, strokes and blood clots by women taking HRT, than those not taking HRT. The preliminary results of this study prompted researchers to halt the study, and recommend that healthcare providers notify clients to stop using the drug.

What else can women use to relieve the symptoms of menopause? Other ways of relieving symptoms of menopause can be targeted to specific symptoms of menopause, or as an overall prevention of diseases like: heart or coronary artery disease, obesity, hypertension, diabetes and stroke. Examples: For hot flashes, it is important for menopausal women to avoid events or situation that trigger them; to minimize the effect of hot flashes, keep a small fan in your place of work, and have one beside the bed to use as needed; drink iced water or juices, and avoid caffeine, cigarettes, or excess use of alcohol. It is also important to maintain a regular exercise regimen, eat a balanced diet and dress comfortable preferable in cotton outfits, and have extra layers of sheets to handle night sweat. For difficulties sleeping: exercise regularly, keep the bedroom comfortable, and avoid caffeine, alcohol or large meals close to bedtime. Also learn to determine the amount of sleep needed, then go to sleep and wake up at the same time everyday, and avoid naps in the day. For vaginal dryness, lubricants may be helpful, but talk with your healthcare provider for specific types to use. For menopause symptoms that persist even after these interventions, always talk with your healthcare provider.


**obtained from the urine of pregnant horses. As for progesterone, a type which is synthetically made is called “progestin”. Natural progesterone are nearly as identical to the hormones made by the woman’s body are also available in the combination hormone treatment for menopause.
 

CHICAGO, IL -- January 25, 2000 -- Women who are current or recent users of estrogen-progestin hormone replacement therapies (HRT) for treatment of menopause symptoms have a higher relative risk of breast cancer than women who only take estrogen, according to an article in the January 26 issue of The Journal of the American Medical Association (JAMA).

Catherine Schairer, Ph.D., and colleagues from the National Cancer Institute in Rockville, Md., analyzed follow-up information from a subset of postmenopausal women (46,355) who participated in the Breast Cancer Detection Demonstration Project, a nationwide breast cancer screening program. The researchers compared the new cases of breast cancer with the type of hormone replacement therapy used for this group of women who had no previous evidence nor diagnosis of breast cancer. There were 2082 cases of breast cancer identified during the 1980 through 1995 follow-up period.

"Our results suggest that the combined estrogen-progestin regimen is associated with greater increases in breast cancer risk than estrogen alone," the authors write. "Assessing the comparative risk of estrogen alone vs. estrogen-progestin was complicated by the fact that use of estrogen alone was associated with increased risk in lean but not heavy women. We found differences between the two regimens [estrogen-only and estrogen-progestin HRTs] among lean women but were unable to draw conclusions among heavier women."

The researchers analyzed the data from follow-up questionnaires and interviews After adjusting for such factors as age at menopause, regularity of receiving mammography, education and age, they found that the relative risk of being diagnosed with breast cancer was 20 percent higher for those categorized as "recent users" (current use and past use occurring within the previous four years) of estrogen-only HRT compared to women who had never used HRT. Adjusting for the same variables, the relative risk was 40 percent higher for "recent users" of estrogen-progestin HRT compared to women who had never used HRT.

The researchers found that for recent users of estrogen-only HRT the relative risk of being diagnosed with breast cancer rose by 1 percent for each year of its use, after adjusting for age at menopause, mammographic screening, body mass index, education and age. For recent users of estrogen-progestin HRT the relative risk of being diagnosed with breast cancer rose by 8 percent for each year of its use.

Citing previous research the authors note: "In a recent collaborative reanalysis of more than 90 percent of the world's epidemiological data on the relationship between menopausal hormone replacement therapy and breast cancer risk, it was found that longer durations of recent, but not past, use of HRT increased breast cancer risk, particularly among leaner women and for tumors that were less clinically advanced."

(JAMA. 2000;283:485-491)

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