Hormone or Not

To hormone
OR
Not to hormone….

That is the question ...
for many menopausal and peri-menopausal women. This dilemma has been made more difficult with recent media attention to a new study that appeared in the Journal of the American Medical Association (JAMA) on January 26. In this study, the risks of developing breast cancer in women taking hormones during and after menopause were reexamined. This study confirmed some of our existing knowledge about these risks, while, in other areas, it is sounding a wake up call to perhaps change the way we counsel patients.

Menopause is a phenomenon that occurs only in humans, not even in other primates. While sociologists are trying to decipher the purpose of menopause, endocrinologists see it truly as a hormonal deficiency status, not very different from insulin deficiency in diabetes or thyroid insufficiency. Accordingly, many of the subsequent problems that occur in women later in life, like cardiovascular disease, osteoporosis, colon cancer, Alzheimer's disease, etc., can be attributed to or worsened by the absence of estrogen as a result of menopause.

"I don't want to increase my risks for breast cancer", say many of my patients. Some women have a family history of breast cancer and are even more concerned. What exactly are these risks? Let's look the results of the new study. This is a good study involving over 46,000 women in the Breast Cancer Detection Demonstration Project (BCDDP), followed since 1973! It compared three groups: those who took estrogen alone, estrogen combined with progesterone, and those that took no hormones whatsoever. Those that took estrogen alone had a 34% increased risk of breast cancer; the combined hormone group had a 53% increased risk above those that took no hormones!

The good news is that the study also demonstrated no increase in risk for the first 4-5 years of use, and that the increased risk was not demonstrated in heavy women. This means that women who are just beginning menopause or still have disabling symptoms can be counseled to consider hormone replacement. For all women unsure as what to do, we need to sit down and discuss their individual and personal risk (not all women have the same risk!). All alternatives, both natural and pharmaceutical, need to be addressed.

There is no doubt that hormone therapy can be a legitimate component of preventive healthcare for women. The risks, however, must be individualized for each woman. It is also extremely important to realize that her decision is only for now, and should continually be reevaluated with new information. We can help you decide because we are not an HMO and have no financial incentives in any products or pharmaceuticals. We are your advocates!

Next month I will begin discussing menopausal solutions, including natural ones.