Nonoral HRT May Be Safer
Women in European Study Had Lower Cardiovascular Risks, Blood Pressure
Oct. 10, 2002 -- Women wishing to stay on hormone replacement therapy (HRT) who are concerned about the potential health risks may want to consider abandoning oral treatment in favor of other delivery routes, new research suggests.
Investigators conducting a small European study in which HRT was given in the form of estrogen skin patches and vaginally administered natural progesterone say these methods may be free of the cardiovascular risks that have recently been associated with oral hormone therapy. As an added benefit, postmenopausal women who were on the regimen for one year lost weight, lowered their blood pressure, and had less vaginal bleeding.
But a menopause expert contacted by WebMD says even though some women are better off taking nonoral HRT, there is little evidence that all women would fare better on nonoral regimens.
"One size definitely does not fit all when it comes to hormone replacement therapy," North American Menopause Society (NAMS) executive director Wulf Utian, MD, PhD, tells WebMD. "When a women talks to her healthcare provider about HRT, the discussion should include not only whether she should take it, but what regimen she should be on."
In light of the recent controversy surrounding HRT, a NAMS panel recently issued a report clarifying its position on the treatment. The panel concluded that relief from the symptoms of menopause should be the primary reason for being on HRT and that women should take the treatment for the shortest time possible.
Panelists also called on physicians to consider alternatives to oral HRT, such as creams and patches. But they added that there is no clear evidence that nonoral delivery carries fewer risks than the oral drug Prempro, which has been linked to an increased chance of heart attack, breast cancer, and stroke.
Utian says there is good evidence that women who are extremely overweight, diabetic, or have high blood pressure should avoid oral therapy, but it is not clear whether women without specific risk factors need to do so. Utian is a consulting gynecologist at The Cleveland Clinic and an emeritus professor at Case Western Reserve School of Medicine.
The European study included 35 postmenopausal women who were treated for one year with estrogen patches and a natural progesterone gel, administered twice weekly. Though uterine bleeding is a common side effect of HRT, two-thirds of the women had no such bleeding during the one year of the study. The women also lost weight and lowered their blood pressure. The study was published in the September issue of the American Journal of Obstetrics and Gynecology.
The authors suggest that the weight loss and the decreases in blood pressure may have been associated with the use of natural progesterone in the HRT regimen, rather than the synthetic form of the hormone that is commonly used.
"Our data fuel the emerging concept that HRT regimens using synthetic progestins and (natural) progesterone are not equivalent as far as weight gain is concerned and that natural progesterone administered nonorally may have benefits ignored until now," lead researcher Estore Cicinelli, MD, and colleagues write.
"Considering the clinical soundness of avoiding all possible drawbacks from oral and/or synthetic progestins, most notably on the cardiovascular system, twice-weekly administration of transdermal (estrogen) and vaginal progesterone is a viable option for long-term HRT." -->