Hormone Therapy: For Whom? How Long?
When Is Menopausal Hormone Therapy Appropriate? Expert Panel Weighs In
Finding the Bottom Line continued...
For women without a uterus -- that is, women who have had a hysterectomy -- the panel found that:
- Oral, standard-dose hormone therapy is appropriate only for women with normal risk of heart disease and normal risk of blood clots. It is uncertain for women with normal blood clot risk and elevated risk of heart disease.
- Oral, low-dose hormone therapy is appropriate only for women with normal risk of heart disease and blood clots. It is uncertain for women with either one of these risks alone, but not both together.
- Transdermal hormone therapy is appropriate for women with normal heart disease/blood clot risk and for women with only one of these risks. It is uncertain for women with elevated risk of both heart disease and blood clots.
- For all other combinations of heart disease/blood clot risk or stroke/TIA history, hormone therapy is inappropriate.
"You want to relieve a woman's intolerable symptoms, but you don't want to create other health problems at the same time," Ettinger says. "There is a certain level of comfort we have in prescribing any form of hormone therapy for a woman who is healthy. And there is a high level of discomfort in prescribing hormone therapy for a woman at risk of stroke or heart attackheart attack -- even if she has intolerable symptoms."
The panel strongly recommends that after a woman has been on hormone therapy for a year, she should try to stop or at least take a lower dose. At every annual checkup, the panel advises, doctors should revisit this issue and urge women to stop or taper off their hormone therapy.
Will the Ettinger panel's recommendations calm the roiled waters of opinion over menopausal hormone therapy? Another metaphor may better apply -- the stirred hornet's nest.
WebMD showed the panel's recommendations to two experts. Both served as researchers in the Women's Health Initiative study. Lawrence Phillips, MD, is professor of endocrinology at the Emory University School of Medicine in Atlanta. Mary Jo O'Sullivan, MD, is professor of obstetrics and gynecology at the University of Miami Miller School of Medicine.
"This is not at all helpful. It is false," Phillips tells WebMD. "Hormone therapy is beneficial for younger women -- that is, women who begin at menopausemenopause. It is not good for women to start after menopause."
Phillips says the Ettinger panel is packed with people opposed to hormone therapy. He says there is strong evidence that hormone therapy, begun during menopause, actually cuts a woman's risk of heart diseaseheart disease. And while he certainly says he thinks doctors and patients should discuss whether to continue hormone therapy at every visit, he sees no reason to urge women to stop.