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    For Hormone Replacement Therapy, Less Is More


    Expert Nancy R. G. Church says, however, that "low dose" is a relative term. This new formulation is a lower dose than Wyeth-Ayerst's current Prempro formulation, but other manufacturers make hormone replacement therapies with slightly different versions of female hormones that are also quite low dose. These products also have been shown to reduce symptoms of menopause effectively with a low risk of side effects.

    More notably, Church is concerned that this low-dose new product will not have the most important benefits of hormone replacement therapy, namely reducing the risk of developing heart disease and osteoporosis.

    "[Preventing] heart disease and osteoporosis are the most important reasons for being on hormone replacement therapy," she says, "and these two research articles don't address those [issues] at all." Church is an obstetrician and gynecologist in private practice in Chicago.

    Both Archer's and Pinkerton's reports are based on the Women's Health, Osteoporosis, Progestin, Estrogen (HOPE) Study. This large research project took place at many health centers across the nation and involved more than 2,600 healthy, menopausal women.

    The women were given either current or lower doses of estrogen or progestin or a combination of both therapies. Some women received only placebo, for comparative purposes. Neither the women nor the researchers knew until the end of the study who received which medication. After one year, the researchers examined the effect of each medication dose on hot flashes, vaginal bleeding, and vaginal changes.

    Pinkerton and colleagues found that the low-dose pill reduced the number and severity of hot flashes and vaginal changes just as well as the currently prescribed dose pills. Also, Archer and colleagues found that women taking the low-dose hormones were less likely than those taking the current dose to experience vaginal bleeding.

    Results of the effect of low-dose hormones on cholesterol and bone health will be published shortly and are expected to show equally positive results.

    If you are taking hormone replacement therapy and it is working for you without causing problematic side effects, stick to your treatment. If you are experiencing difficulties, talk to your physician, who will help you decide whether you need to switch to another, possibly lower dose option.

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