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Great! But Not for Everyone Hormone Replacement Therapy By Bev Todd Two years ago, Kimberly Lewis underwent a total hysterectomy to eliminate symptoms from fibroid tumors in her uterus. As a result, she experienced surgical menopause. “I was cranky. I couldn’t sleep. And because of the hot flashes, I ran a fan and kept my office so cold people wouldn’t come in,” she laughs. To replace the hormones her body Rosalind Jackson, MD Tiffany Hall, MD Steven D. Kilian, MD was no longer able to produce, Kim began taking a combination of estrogen which is prescribed for patients without benefits, from relief of menopausal and progesterone called Premarin®. a uterus—did not have an increased risk symptoms, to protection from Then the first Women’s Health Initiative of breast cancer. osteoporosis, to improving bladder (WHI) study results were published and Good for Some, Not for All covered widely by the news media. Study In fact, HRT can provide a wide range of function. However, hormone replacement is not for everyone. findings indicated a relationship between hormone replacement therapy (HRT) and increased incidence of breast cancer. With a history of cancer in her family, Kim stopped taking her hormone medication. A year of hot flashes, night sweats, interrupted sleep and crankiness forced Kim back to the doctor. “I knew I had to do something!” she says, so she called Rosalind Jackson, MD, an OB/GYN on staff at Miami Valley Hospital. After examining Kim and reviewing her medical history, Dr. Jackson explained a second set of WHI findings showed patients who received estrogen only— Kim Lewis, shown with her dog Avator, is sleeping better, doesn’t suffer from hot flashes and is no longer cranky. She credits hormone replacement therapy for the transformation. P R O H E A LT H | H O R M O N E R E P L A C E M E N T T H E R A P Y 5 “HRT is individualized medical therapy,” says Steven D. Kilian, MD, an OB/GYN practitioner for more than The National Institutes of Health (NIH) established the Women's Health Initiative (WHI) in 1991 to address the most common 25 years and clinical associate professor causes of death, disability and impaired quality of life in post- of OB/GYN at Wright State University menopausal women. The WHI, which addressed cardiovascular Boonshoft School of Medicine. Echoing disease, cancer and osteoporosis, was a 15-year, multimillion Dr. Jackson’s viewpoint, Dr. Kilian says, “We always evaluate the patient’s symptoms, her own medical history dollar endeavor, and one of the largest U.S. prevention studies of its kind. and her family’s medical history; and we run lab tests and bone density tests. If she has ever been on HRT, we find out how long it’s been since she stopped taking it. All of this helps us weigh whether HRT is the right choice for that patient.” Pluses, Minuses and Alternatives used to treat dryness that can occur in example, he notes the average age of menopause, are effective locally; since women in the study was 63, which is they do not circulate through the body, well past the usual onset of menopause; even breast cancer patients can use participants who had taken estrogen them. at any time prior to the study were “The trend is to use the lowest dose excluded; the progesterone prescribed As with all medications, doctors and of hormones that will relieve the was too strong; and the study was not patients must balance the benefits of patient’s symptoms,” Dr. Jackson says. adjusted to reflect the participants’ the treatment against its drawbacks. “HRT is most effective when patients other health conditions. “For instance,” Dr. Kilian explains, “if a begin taking hormone replacements patient has no indication of osteoporosis as soon as menopausal symptoms relationship between estrogen and and no difficult menopausal symptoms, develop—or even during perimenopause, breast cancer is not a clear-cut issue. there may be no need for HRT. And if the the transitional time between having There should be no blanket decisions patient has one or more high-risk factors, regular periods and none at all.” about prescribing HRT.” such as a family history of breast cancer “Estrogen even offers some protec- Dr. Kilian says emphatically, “The Drs. Jackson and Hall agree. or problems with blood clots, elevated tion against memory loss,” Dr. Kilian “Estrogens are wonderful, but they are cholesterol or liver function, we probably says, “but it must be started before the not for everyone,” Dr. Jackson says. would not prescribe HRT.” estrogen receptors in the brain have “We always discuss the risks and shut down, which happens about three benefits of HRT and the alternative methods of administering HRT can years after the body stops producing forms of treatment that are available,” overcome some of these problems. estrogen or after a patient stops taking adds Dr. Hall. “Our obligation is to Tiffany Hall, MD, who practices with HRT.” However, he feels that hormone inform the patient to help her make the Dr. Jackson, explains that pills, taken replacement can still be beneficial for right decision.” by mouth, produce varying levels of other menopausal symptoms whenever medicine in the system and must be it is prescribed. The good news is that alternative processed by the liver. Transdermal So, what about the disturbing find- patches, on the other hand, provide ings from the WHI study that led many an even dose of medication, delivering women and their doctors to discontinue it directly to the blood stream and HRT? Dr. Kilian believes the study’s bypassing the liver. Vaginal tablets, methodology affected the findings. For 6 SUMMER 2007 | MIA MI VALLEY HOSPITAL Kim is positive she made the right decision. “I could do a commercial for HRT,” she laughs. “It’s the best!” To find an OB/GYN doctor in your area, call CareFinders at (866) 608-FIND (3463).