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The Verdict Goes against HRT

In July, the Women’s Health Initiative (WHI), which was studying the effects of combined estrogen and progestin use in postmenopausal women, was halted. It ended three years early after researchers observed an increased risk of breast cancer, potentially deadly blood clots, strokes, and heart disease in women taking hormones (compared to those in the placebo group who remained drug free). Despite the conclusion, several media reports de-emphasized the findings, saying that the risks for each individual woman were small: just eight women out of 10,000 taking hormones would develop breast cancer, eighteen would develop blood clots, eight would have strokes, and seven would have heart disease. Upon closer examination, however, the dangers add up much more dramatically.

Results of the 16,000-woman study were highly anticipated by physicians and their female patients as well as drug manufacturers with a major stake in the outcome. After all, the use of hormones to alleviate menopausal symptoms began just a few decades ago. Despite a lack of scientific evidence showing that its benefits outweigh its considerable risks, many physicians began prescribing hormone therapy long after hot flashes and night sweats subsided, believing it would help prevent chronic diseases that are common in North America. For years, PCRM medical experts have been helping women sort through the science.

Simply put, the WHI study found that women taking hormones for five years have a 26 percent increased chance of developing breast cancer. If the study had continued for a decade—the length of time many women take hormones—80 women may have developed breast cancer based on emerging trends. And the trouble didn’t end there. The risk of heart attack for women in the hormone group was 29 percent higher than for those in the placebo group. For strokes and blood clots, risk increased 41 and 111 percent respectively. To put it another way, 41 serious events took place in the first year of the study, suggesting that, if the six million American women now taking hormones continued for the next decade, 246,000 life-threatening illnesses would be expected.

To the surprise of many women, research has been uncovering holes in the hormone story for years. A 1999 study found that estrogen replacement therapy in women after menopause did not protect against heart attacks. An earlier study in the Journal of the American Medical Association reported that, if anything, hormones aggravated heart problems and contributed to blood clots and gallbladder disease. In 2001, the American Heart Association advised women with cardiovascular disease not to rely on hormones to protect their hearts. Again, in 2002, the nearly seven-year-long Heart and Estrogen/Progestin Replacement Study (HERS) confirmed that hormones did not reduce the risk of heart problems in postmenopausal women with heart disease. In fact, their risk of blood clots doubled—indeed, three women died from blood clots lodging in their lungs during that study—and their need for gallbladder surgery increased as well. Now many are wondering why physicians didn’t disclose these findings earlier.

As Jacques Rossouw, acting director of the WHI, acknowledged, drug industry marketing in the form of multi-million dollar ad campaigns to doctors and patients alike has a profound effect on health care decision making. “We hope the truth will win out over advertising,” he said. Good marketing, unfortunately, succeeds in bolstering a product’s attributes and playing down its flaws, even in the case of prescription drugs.

The good news is that women can sidestep the issue of estrogen use entirely by taking a more natural approach to menopause. The single most important step even young women can take is to eat more fiber-rich foods such as vegetables, fruits, beans, peas, lentils, and whole grains. Many women in other parts of the world who grow up eating a vegetarian diet pass through menopause with hardly a hot flash. The reason is that high-fat animal products (meat, cheese, dairy products, and eggs) can artificially increase the body’s circulating estrogen throughout life, making the hormone shift at menopause feel much worse.

Fiber-rich plant foods do just the opposite by removing excess estrogen. They are nature’s way of balancing hormones. Soy foods such as tempeh, tofu, and soymilk contain phytoestro gens (plant estrogens) that attach to estrogen receptors on cells that would otherwise be occupied by the body’s own estrogen, thereby lowering cancer risk. A low-fat diet free of animal products also protects against heart disease and osteoporosis.

Further information can be found in Healthy Eating for Life for Women, a comprehensive book exploring the many ways that foods influence health. Call 202-686-2210.

Stopping HRT? Here’s How

1. First, see your doctor.

2. Your physician will gradually taper you to the lowest possible dose so that, when you stop, your transition will be smooth.

3. After you stop HRT, you may experience a recurrence of hot flashes. They will go away with time, and may be reduced by exercise.

4. HRT was never a good way to protect your heart. Instead, the best protection comes from a low-fat, vegetable-rich, vegan diet supplemented with vitamin B12, regular exercise, and no smoking.

5. To protect your bones, get plenty of exercise, along with vitamin D from sunshine or supplements, vitamin C from fruits and vegetables (to build the collagen matrix in bone), and calcium from green vegetables, beans, or fortified juices. Avoid animal protein and excess salt (both deplete calcium).

6. Doctors also prescribe statin drugs for cholesterol-lowering and non-hormonal drugs [e.g., raloxifene (Evista) and alendronate (Fosamax)] for osteoporosis. Be aware that all have both benefits and serious potential risks.

“The most important thing to remember is that all women are different, with different risk profiles for the sequelae of menopause. Each woman should have her own risk profile determined—very simply by obtaining a fasting cholesterol, a DEXA bone density study, and an evaluation of her dietary and exercise habits,” says Sam Jacobs, M.D., associate professor of OB/GYN at Robert Wood Johnson Medical School. As you stop HRT, your doctor will want to individualize whatever other treatments are prescribed.


Autumn 2002 (Volume XI, Number 3)
Autumn 2002
Volume XI
Number 3

Good Medicine

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