|
|
|
By Dr. Tim Malling, PAHCS
Recently, some results from the Women's Health Initiative (WHI) have brought into question the safety of a certain mix of estrogen/progesterone called Prempro. The media presented this safety concern to the public without giving much information about the actual findings. I hope that by presenting the actual study findings, patients that are either on CHRT or are trying to make a decision about starting CHRT can make a more educated decision. The study included 16,608 women who had gone through menopause. A little over half received CHRT, the other half received placebo (identical looking pill with no medicine in it). After 5.2 years of treatment, one part of the study was stopped because of some concerning findings. In this part of the study, it was noted that in the first 2 years of treatment the risk of heart attacks went up 29%, the risk of strokes went up 41%, the risk of blood clots doubled, and the risk of invasive breast cancer went up 26% in women on the CHRT. But if you look at the actual numbers instead of the percentages, the results don't look quite so dramatic. The risk of heart attack went from 30 per 10,000 patient years, to 37 per 10,000 patient years. This is a 29% increase, but the actual numbers increase is 7 heart attacks per 10,000 patient years. Likewise, the stroke risk went from 21 to 29 per 10,000 patient years; the risk of blood clots went from 16 to 34 per 10,000 patient years; and the risk of invasive breast cancer went from 30 to 38 per 10,000. So despite the negative findings, the actual numbers show the risk to still be quite small. It also should be noted that the hormones have positive effects. The risk of colon cancer went down 37% (from 16 to 10 per 10,000 patient years) and the risk of hip fracture went down 33% (from 15 to 10 per 10,000 patient years). This all means that if 100 women who had gone through menopause took this CHRT for 5 years, you could expect two additional episodes of heart attack, stroke, blood clots, or invasive breast cancer in the group. But you could also expect one less episode of colon cancer or hip fracture. This part of the study only assessed Prempro, not plain Premarin or any other formulation of CHRT. The part of the study looking at plain Premarin is continuing, and it is still felt to be quite safe at this time. Estrogen has been shown to be beneficial for treatment of hot flashes and other menopausal symptoms, as well as for prevention of osteoporosis (bone thinning). But there are a lot of other treatments for these problems other than Prempro. A discussion with your health care provider is the first step in trying to discover what option is best for you.
|
Combined Hormone Replacement Therapy (CHRT) is the use of an estrogen hormone to try to overcome some of the signs and symptoms of menopause, and a progestin type hormone to help protect the uterus from the estrogen.