New
information on the benefits and risks of hormone replacement therapy
for postmenopausal women has just been released from the National
Institute of Health sponsored study called the Women’s Health
Initiative. This study was designed to assess the long-term
risk/benefit ratio of estrogen replacement therapy (ERT) and
combination estrogen plus progestin (HRT).
In summary, it
appears that on the combination HRT there is a small increased absolute
risk of invasive breast cancer (8 per 10,000 women) over an average
follow-up period of 5.2 years. There was also a slight increase in the
absolute risk of heart attacks (7 per 10,000 women), strokes (8 per
10,000 women) and blood clots (18 per 10,000). There was also a
decrease (a beneficial effect) in colorectal cancer (6 per 10,000
women) and hip fractures (5 per 10,000 women). The absolute risk of
harm to an individual woman is very small, however these risks led
investigators to ask patients taking the combination HRT to discontinue
their medication.
Note that this report applies only to the use
of combined estrogen and progestin, not the use of estrogen alone.
There appear to be no difference in breast cancer rates among women on
estrogen alone, suggesting that the combination acts differently than
estrogen alone. The estrogen only portion of the study is continuing.
Results from this study will become available in 2005.
The
conclusion of the researchers was that women should not take combined
HRT for disease prevention. There is no recommendation that it should
not be taken for time-limited treatment of symptoms that are affecting
quality of life. In analyzing the pros and cons women should not lose
sight of the primary indications for which HRT has been approved:
alleviating hot flashes, sleep disturbances, mood changes, and vaginal
atrophy and dryness.
These results obviously require that the
risk/benefit ratio of this treatment should be reassessed for each of
you in light of what is known, taking into account your preferences and
your individual history and requirements.
One should also know
that there are other options for achieving some of the benefits
attributed to HRT- topical estrogens for vaginal dryness, statins for
lowering cholesterol, antidepressants or other medications for hot
flashes, and a variety of drugs for bone loss.
We suggest the following options:
·You
may continue your present prescription until your next scheduled visit,
at which time we will fully assess your options for treatment.
·If
you wish, you could stop your HRT now and observe and record your
symptoms while off the medicine. If you are on continuous estrogen and
progesterone it is possible that you will bleed for a short period
after stopping the medication.
·If the above options do not
seem right for you, we suggest that you schedule an appointment before
your next regular visit so that we can discuss the best choices for you.
We
would emphasize that the risks shown by this study are of a low order
of magnitude so that continuing your therapy presents a minimal risk of
complications. For instance, the increased risk of breast cancer is
less than a tenth of 1 percent per year. Also, the short-term quality
of life benefits you may experience may lead you to choose to continue
the treatment for some period of time.
With our best wishes and continuing concern for your health,
Lionel J. Schewitz, MD David C. Schewitz, MD Leslie G. Oshin, MD
Max Schewitz Foundation
The
Max Schewitz Foundation is a nonprofit organization founded in 2006 by
the family and friends of Max Schewitz who died from sudden cardiac
death at the age of twenty. The Max Schewitz Foundation's mission is
two-fold:
1. To support education, prevention, and research of sudden cardiac death in young people. 2.
To support environmental conservation, a lifelong area of interest to
Max. Specifically to support through education and conservation fragile
and threatened ecosystems and species.
Sudden cardiac death,
which can have multiple causes, accounts for approximately 300,000
deaths per year in the United States, topping deaths from lung cancer,
breast cancer, and AIDS. 31% of coronary-associated deaths were sudden
deaths in people aged 20-29 years. That means that often the first sign
of cardiac problems in this age group is death. This underscores the
need for development of early detection to increase survival rates.
The
conservation and preservation of fragile and threatened reptile
ecosystems and species was Max?s passion as evidenced by his many years
of work in the field, educating the general public, assisting in
biological research projects, breeding rare species, and investigating
reptiles in their native habits worldwide. Now, his work in the field
of education and preservation can only continue through the generosity
of others.
The Max Schewitz Foundation seeks to grow funds to
enable scientists to help prevent deaths of talented young people like
Max and to continue his work in the conservation and preservation of
fragile ecosystems and species.
Donors will be able to choose
their focus of interest and be assured that funds will be applied to
research or education in the chosen interest area. For more information please click on the WEB LINK or visit www.maxandthewildthings.com
