Big Question on Hormone Therapy: What Next?

It has been nearly three years since a landmark government study squelched the notion of hormone therapy as preventive medicine, leaving millions of women wondering how they should treat their hot flashes and other symptoms of menopause.

That question will be the focus of a three-day ”state of the science” conference beginning today at the National Institutes of Health.

”We hardly know anything,” says conference speaker Deborah Grady, a University of California, San Francisco, internist and epidemiologist who will discuss issues related to discontinuation of hormone therapy.

For the most part, Grady and other doctors who treat and study menopausal women have advised that those with intolerable menopause symptoms take as low a dose of estrogen (plus progestin, if they still have their uterus) as possible for as short a time as possible.

But, Grady says, there’s not even a consensus about what constitutes menopause symptoms, let alone how best to treat them.

”Is irritability a menopausal symptom? Is fatigue a menopausal symptom?” she asks, noting that what little research has been done on the subject suggests that the answer to both of those questions is no. ”Are there alternative treatments for them?”

Clearly, estrogen relieves hot flashes, experienced by about one-third to one-half of menopausal women, Grady says. About one-fifth of menopausal women believe their hot flashes are severe enough to warrant treatment, she says.

Grady says she prescribes hormone therapy for such patients, but ”they’re scared witless the whole time they’re going to be on it.” It’s fine if patients want to try black cohosh, an herb sold as a dietary supplement that preliminary research suggests might help relieve hot flashes, Grady says.

Acupuncture, magnets, reflexology and homeopathy are other, less-studied alternative therapies that will be discussed at the NIH conference.

The meeting also will cover the latest research into non-hormonal drug treatments, such as antidepressants, high blood pressure medications and an anti-seizure drug. And Robert Freedman, a Wayne State University professor of psychiatry and obstetrics and gynecology, will discuss behavioral treatments for hot flashes.

The government study that led to a dramatic decline in postmenopausal hormone use found that estrogen plus progestin, sold as Prempro, not only doesn’t protect against heart attacks and strokes as once thought, but also increases users’ risk of those ailments and breast cancer, the study found.

About a year and a half later, the same study concluded that estrogen alone raised stroke risk and didn’t have any effect on heart disease risk. Although researchers were surprised to find a lower risk of breast cancer in estrogen users compared with those on placebo, the number of cases was too small to rule out chance as the explanation.