Hormone Replacement Therapy May Still Be Of Value To Certain Women

According to two physicians at Cedars-Sinai Medical Center in Los Angeles -- a cardiologist and an internist with a specialty in alternative medicine -- it is important for menopausal women to know and understand all of their options, so they can make educated decisions affecting their healthcare. It is equally important to understand the role that HRT or safe alternatives may play during menopause.

For years, HRT has been used to relieve the symptoms of menopause and to reduce the risk of heart disease and prevent bone loss. But studies have shown conflicting results, with some showing health benefits while others show that the drugs actually harm the heart. Thus, a major clinical trial known as the Women's Health Initiative was launched five years ago to evaluate the potential benefits of HRT, but was stopped last month when results showed that long-term use of the drugs increased women's risk for breast cancer, stroke and heart disease.

"While it is certainly significant when a major, national clinical trial is stopped, it's important to understand that the actual increased risk for any of these conditions was very small and the breast cancer risk occurred only in women who were on the therapy for five years," said C. Noel Bairey Merz, M.D., Holder of the Women's Guild Chair in Women's Health, and Medical Director of Women's Health at Cedars-Sinai. "Notably, the death rate did not increase at all," she said, adding that the estrogen-only component of the trial was still ongoing.

The study indicated that for every 10,000 women taking combined HRT each year, there would be seven more heart attacks, eight excess breast cancers and eight more strokes than would have occurred had the drugs not been taken.

According to Dr. Bairey Merz, there are "trade-offs" when it comes to HRT. For some women, the benefits of continuing the therapy may outweigh the risks. For example, the study has shown a strong reduction in hip fractures for women on HRT, which means that women with a family history of osteoporosis or brittle bones might want to consider continuing the therapy. However, it is very important that they undergo mammograms annually to screen for breast cancer, she emphasized.

While some women opt to continue with HRT under carefully monitored conditions, others may want to seek reliable alternative remedies.

"Now, more than ever, it is critically important for menopausal women to know their options," said Dr. Mary Hardy, Medical Director of the Integrative Medicine Program at Cedars-Sinai. "Herbal remedies, diet, exercise and well-proven treatments that reduce the risk of heart disease and osteoporosis should all be discussed with the patient's health care provider."

Alternative therapies begin with modifying your lifestyle and diet, as well as using herbs and other supplements. "Maintaining a healthy weight, learning relaxation techniques and making good nutritional choices such as reducing alcohol intake can all help," says Dr. Hardy. "Alcohol consumption can actually cause flushing," she adds. Dr. Hardy recommends adding to your diet fiber and legumes, such as soy, which are rich in protein and isoflavones. Isoflavones, commonly referred to as phytoestrogens, are compounds in plants that can bind to estrogen receptors and thereby modify the action of estrogen in the body. In addition, soy protein has been designated a heart healthy food.

Beyond lifestyle changes, botanical interventions can also offer women good alternatives. Extracts of phytoestrogen rich plants, such as soy or red clover, have been shown in research studies to decrease symptoms of menopause and may help maintain healthy bones. However, there is concern over the theoretical risk that these weakly estrogenic compounds may cause. Black cohosh, a native American plant without estrogenic activity, has been shown in a number of clinical trials conducted in Europe to be helpful for relieving the symptoms of menopause without this theoretical risk.

Given our multi-ethnic society, it is not surprising that a number of remedies taken from traditional Chinese Medicine and other cultures, are being used by increasing numbers of American women. These interventions, such as herbs and acupuncture, are known to give symptomatic relief, and provide fruitful areas for future research. However, before a woman starts taking unusual remedies, Dr. Hardy advises "Don't forget the basics. Every woman should take enough calcium and vitamin D every day." Choose your calcium carefully so that you get the required amount of a good quality product. You may look to fortified foods and juices to help get in the 1200 to 1500 mg required every day. You may have to get creative if you don't like taking the pills, but don't neglect calcium. It's essential for preventing or minimizing osteoporosis later in life."

For women suffering from vaginal dryness during or after menopause, Dr. Hardy suggests an unlikely sounding, but effective treatment: wild yam cream. Commercially available progesterone creams claim to be made of natural progesterone, but they are actually made from wild yams, a natural vegetable in which the chemical progesterone is found.

"Everything that's natural may not be what you think. So, you need to partner with your health care provider to find the best alternative for you," said Dr. Hardy.

Cedars-Sinai is one of the largest nonprofit academic medical centers in the Western United States. For the fifth straight two-year period, Cedars-Sinai has been named Southern California's gold standard in health care in an independent survey. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthrough biomedical research and superlative medical education. Named one of the 100 "Most Wired" hospitals in health care in 2001, the medical center ranks among the top 10 non-university hospitals in the nation for its research activities.