The Search for HRT Alternatives ; Jumbled Menu of Possibilities

By MARY JO LAYTON, STAFF WRITER

Some 67 million women were on HRT when the 2002 study showed Prempro estrogen and progestin had serious side effects.

Breast cancer rates for American women are on the decline and experts believe it’s because fewer women are on hormone replacement therapy.

Millions of women used HRT for relief from menopausal symptoms until a national study in 2002 found it increased the risk of developing breast cancer and blood clots.

Now, with new data showing a decline in breast cancer, the link between HRT and cancer seems even clearer. Physicians throughout North Jersey say they are much less likely to prescribe HRT to help women ease hot flashes, mood swings and night sweats.

“The vast majority of my patients is no longer using hormone replacement therapy,” said Dr. Joseph Schwartz, a specialist in endocrinology at Holy Name Hospital in Teaneck. “If the symptoms aren’t that severe, the benefits don’t outweigh the risk.”

But five years after millions of women had to abandon HRT, the perfect alternative has yet to emerge.

Menopausal women have to sort through a confusing menu of treatment options, weighing the risks and benefits of everything from estrogen rings and creams to herbal remedies and customized hormones concocted at their local pharmacy.

For some, an option is low doses of antidepressants such as Effexor or Neurontin, a medication approved for the treatment of seizures and other conditions.

Herbal remedies, including black cohosh which is commonly prescribed for women in Europe soy and red clover are also increasingly popular. They are supplements that have isoflavones estrogen-like compounds.

Yet health experts caution that these weaker cousins of the body’s own estrogen haven’t been found to relieve hot flashes in clinical trials.

“The bad news is there’s not one magic bullet,” said Dr. Paul G. Stumpf, immediate past president of the New Jersey chapter of the American College of Obstetrics and Gynecology. “It’s hard sorting through all of the information that’s out there.”

For years, gynecologists treated menopause as a middle-age malady: They prescribed HRT, typically Premarin or Prempro, as estrogen levels began declining and hot flashes, vaginal dryness and mood swings ensued.

“It was a Pavlovian response,” said Dr. Harold Bruck, a breast surgeon at The Valley Hospital in Ridgewood. “Menopausal women were put on hormones, and they were on it forever.”

The medication was even prescribed for women with mild symptoms because physicians believed it protected them from heart disease and helped to increase bone density. Patients themselves were convinced it kept their skin youthful and their weight under control.

Some 67 million women were on HRT when the 2002 study showed Prempro estrogen and progestin had serious side effects. Scientists said Prempro resulted in seven more heart attacks, eight more strokes, eight more breast cancers and eight more blood clots per 10,000 women.

Prescriptions plummeted. In December, an announcement gave women more reason to stay away from HRT: Researchers say the number of new breast cancer cases has declined by 7 percent. The drop was even more significant for women 50 and older, the age when most women reach menopause and would have traditionally begun HRT.

Guiding principle

Today, Bruck and countless colleagues write prescriptions for a much smaller percentage of women. The guiding principle is how to alleviate symptoms with as little medication as possible.

Stumpf strongly urges women to exercise 30 to 40 minutes at least four times a week and to eliminate caffeine and alcohol from their diets.

“Alcohol can be a real trigger for hot flashes,” he said.

In the rare cases when physicians prescribe hormones for menopausal patients, they are turning to smaller-dose prescriptions, including estrogen patches, Estring rings or creams like Etrace.

Gynecologists are more likely to prescribe these remedies for women who enter menopause abruptly because of surgery or cancer treatment when symptoms such as hot flashes can be much more severe than in women who reach menopause naturally.

For most women, finding relief that works for their particular body involves a difficult search and trial and error. And with so many studies touting so many findings sometimes conflicting with one another it’s harder than ever to land on the right solution, said Karen Giblin, founder and president of the Red Hot Mammas, the nation’s largest menopause education organization.

“A lot of women are finding it very difficult to interpret these studies,” Giblin said. “They’re very afraid of getting breast cancer and heart disease. They need a better understanding of how to identify their risk and benefits pertaining to the treatment options.”

Schwartz and many physicians said they are being asked about bio- identical hormones, which are prepared, mixed and assembled by local pharmacists. They are sometimes called “designer hormones” because they are tailored for each woman based on hormone levels obtained through blood or saliva tests.

Examples of these plant-derived compounds include Biest and Triest, which are marketed as “natural” products.

“Keep in mind natural is a marketing word and has no medical meaning,” Bruck said.

The American College of Obstetrics and Gynecology has warned women that “compounded hormone products have the same safety issues as those” produced by drug companies.

“There’s no scientific evidence to support claims of increased efficacy or safety for individualized estrogen or progesterone regimens,” ACOG concluded.

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E-mail: layton@northjersey.com

(c) 2007 Record, The; Bergen County, N.J.. Provided by ProQuest Information and Learning. All rights Reserved.