Should Anyone Take Hormones?

Hor

mone-replacement therapy (HRT), which for years was offered to postmenopausal women as a remedy for nearly everything that ailed them, from hot flashes to heart disease, took another hit last week. The Journal of the American Medical Association published the outcome of a seven-year follow-up study that doctors hoped would show, despite disappointing results the first time, that long-term hormone replacement does in fact protect women against heart disease. Instead, the study showed the opposite. Not only did HRT fail to reduce the risk of heart attacks and strokes, it significantly increased the incidence of blood clots and gallbladder disease.

Coming on top of studies linking HRT to increased risk of breast and uterine cancers, the study might well lead the 17 million American women who are taking hormone-replacement therapy to wonder whether they are making a big mistake. Given all the bad news, are there any good reasons to take hormones?

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It's a fair question, but to answer it you first have to understand that women take hormones for a wide variety of reasons. The new study focused on elderly women (average age: 67) who already had signs of heart disease and were hoping HRT would help ward off further trouble. Dr. Diana Petitti, who wrote the journal's accompanying editorial, is pretty clear about what the study means for this group of women. "Don't start, and do stop," is how she puts it. "HRT just doesn't offer any protection."

But that doesn't mean HRT is worthless for all women. Even Petitti acknowledges that HRT has a role to play in treating what she calls "the acute symptoms of menopause"--which is what the vast majority of women who take it are using it for. These symptoms include hot flashes, mood swings, sleep difficulties and vaginal dryness. If you are a woman who is having difficulties with the onset of menopause and find that HRT relieves your symptoms, there is no reason to stop, at least for now. But after the symptoms subside, usually within a year or two, ask your doctor whether you need to continue hormone therapy; more physicians are starting to view HRT as a short-term rather than a long-range treatment.

Hormone therapy was also believed to prevent fractures due to osteoporosis, but the new study raises questions about that too. Women in the trial who were on hormones had a slightly higher rate of hip fractures than those taking a placebo — the opposite of what was expected. For the definitive answer on this and other unresolved questions, doctors are awaiting the results of the big Women's Health Initiative study of HRT, due out in 2005.

The good news is, other treatments work quite well in combatting heart disease and osteoporosis. Several studies have shown the benefits of aspirin, beta-blockers and, for women at particularly high risk, ace inhibitors to prevent blot clots and reduce high blood pressure. For women with a history of low bone density, biphosphonates (which reduce bone destruction) and raloxifene (Evista) can help ward off fractures.

The best prevention for many postmenopause effects is to stick to the basics before menopause: eat right, drink milk, get plenty of exercise and have your cholesterol and blood pressure regularly checked.

Dr. Gupta is a neurosurgeon and CNN medical correspondent