Download Great! But Not for Everyone Hormone Replacement Therapy

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
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“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
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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!”
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call CareFinders at (866) 608-FIND (3463).