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Hormone treatment not always wrong

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Dr. Mark K. Curtis specializes in hormone replacement therapy.

Dr. Mark K. Curtis specializes in hormone replacement therapy.

Tom Smart, Deseret Morning News

Women — and physicians — who believe the national Women's Health Initiative showed clearly that women should never use hormone replacement therapy didn't read it very carefully or understand what it showed.

The question of hormone replacement therapy can only be answered well on an individual basis, according to Dr. Mark K. Curtis, obstetrician and gynecologist at Cottonwood Hospital.

Curtis and Tina Goldsmith, a licensed nurse practitioner, will be featured during Saturday's Deseret Morning News/Intermountain Health Care hotline. The topic is women's health issues, and the duo will address anything from depression to aging to hormones to osteoporosis. All calls are confidential.

The highly publicized women's health study looked at the effects of Prempro (estrogen and progesterone combined) on post-menopausal women who still have their uterus. The average age of study participants was 63.

Separate groups within the initiative looked at use of Premarin (estrogen alone) in women who have had their uterus removed and those on placebo, meaning they take no hormone enhancement.

Progesterone is combined with estrogen for women who have a uterus because estrogen alone creates problems in the uterus.

The Prempro study was halted early when it became known that relative risk of having breast cancer increased with use of Prempro and that it didn't protect the heart as people thought. Some women had been taking the hormones specifically for those benefits.

But most people didn't understand how much that risk of breast cancer increased — from 450 cases of breast cancer per 10,000 women on placebo to 458 cases per 10,000 women in the Prempro group — or that the placebo and Premarin studies continue today. Only the Prempro study was stopped.

What the study — and more than 60 other studies that each look at slightly different questions and populations — showed regarding hormone use is there's no one answer, said Curtis. Women who have no hormones are at greatest risk of developing atherosclerotic plaque. But adding hormones for women who have not had them for years following menopause increases the risk of stroke. And for the first couple of years when hormones are added after a woman hasn't had her own hormones for a number of years after menopause, the risk of heart attack increases. It's similar to the risks that increase when a woman becomes pregnant and her hormone levels rise dramatically, he said.

The initiative doesn't show what happens to younger women who use Prempro. It also doesn't show what happens if Prempro is used consistently as natural hormone levels drop off in the menopause process. Those things weren't tested.

Indications are, Curtis said, that continuous use of hormones decreases the risk of death by heart attack by almost 50 percent, based on observational studies. And there's no question that hormones relieve many of the symptoms of menopause that make women miserable, including hot flashes and night sweats.

Hormone replacement therapy in numerous studies also shows decreases in spinal and hip fractures, macular degeneration, tooth loss and colon cancer, Curtis said. Since a woman is a "human being and not just a breast walking around," he said, "you have to make a decision based on the individual's life. You can't live 20 lifestyles. You can only live one.

"Women can make a decision that works for them, but you have to give them correct information," he said.

E-MAIL: lois@desnews.com