Managing Menopause: What to Do?
Hormone Replacement Therapy May Be OK Short Term
June 20, 2003 -- Bone fractures, hot flashes, heart disease, dementia, breast cancer -- older women have big health concerns. But what should they do, with so many conflicting findings about hormone replacement therapy?
A panel of experts offered their advice today, based on research from the Women's Health Initiative (WHI). It's part of The Endocrine Society meeting being held in Philadelphia.
HRT does indeed improve an aging woman's bone health; In fact, the FDA has approved HRT for that specific purpose. But should a woman take HRT just for bone health? Only if hot flashes are getting the best of her, says Ethel Siris, MD, director of the Osteoporosis Center atColumbia-Presbyterian Medical Centerin New York.
"Women who are miserable, have poor quality of life because of hot flashes, in my opinion should get HRT for a short term. But if they are using it solely for bone health, there are other treatment options that should be used," Siris says.
The bone benefits of HRT are not linked to how long women take it, she says. "It's a case of 'what have you done for me lately.' Hormone replacement therapy works only as long as you take it, but if you stop you will have bone loss. It's critical that women who stop taking HRT not forget their bone health."
Most bone loss occurs in early menopausal years, she says. "That means women better find out where they stand in terms of bone health. Bone testing is very critical in women who quit HRT, to see if they need other treatment for bone health. If bone density is low, another therapy should be given, and given promptly."
Other treatments are highly effective and very safe, she says. "Each is somewhat different from the other, which means we can individualize treatment to fit the patient."
Among those options:
- Bisphosphonates are bone-specific drugs that prevent bone loss and reduce fracture risk.
- Selective estrogen receptor modulators (or SERMs) are drugs that are not hormones -- not estrogens -- but they can prevent bone loss and reduce breast cancer risk. However, women may get an increase in hot flashes and vaginal bleeding.
- Another new drug, called Forteo, for severe osteoporosis -- especially for people who have had fractures -- actually stimulates bone formation (other drugs block bone loss). It requires daily injections.
Heart disease is another big issue for aging women -- but "we're still getting reports from WHI that combined HRT is not effective in preventing heart disease," says Ellen W. Seely, MD, director of endocrinology, diabetes, and hypertension research at Brigham and Women's Hospital in Boston.
Yet heart disease kills more women than does breast cancer. If women can't take hormone replacement therapy, what can they do?