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Women Warned To Avoid Hormone Therapy

Jan 9, 2004 | The Globe & Mail

Women should not take hormone-replacement therapy to treat the symptoms of menopause, except in rare instances, the Canadian Cancer Society said yesterday in one of the bluntest public health warnings yet issued about the controversial treatment.

Women with a personal or family history of breast cancer should be particularly leery, according to the new recommendations.

"Current research shows the risks of combined HRT including the increased risk of breast cancer outweigh the benefits," Heather Logan, the society's director of cancer control policy, said.

The recommendations draw renewed attention to a bombshell study published in July, 2002, showing that the combination of estrogen and progestin, the standard treatment for menopausal symptoms for decades, is fraught with health risks. In addition to hiking a women's breast-cancer risk, HRT increases the risk of heart disease, stroke, blood clots in the lungs and dementia. However, the drugs reduce the risk of hip fractures and colorectal cancer and can be effective in treating some symptoms of menopause, such as hot flashes.

Mrs. Logan stressed that the Cancer Society was not giving medical advice and that every woman should make an individual decision after consulting with her physician.

New research, however, shows that women are abandoning HRT in droves.In the United States, prescriptions for HRT have plummeted by almost 40 per cent since July, 2002, according to a study in this week's edition of the Journal of the American Medical Association.

There are no comparable Canadian figures, but a small poll conducted one year ago by Pollara revealed that 44 per cent of women using HRT had stopped taking the drugs and another 32 per cent said they would discontinue HRT in the future. According to Statistics Canada, about 1.2 million women took HRT in 2001.

U.S. researchers estimate that prescriptions for hormone treatments will total about 57 million for 2003, down from 91 million in 2001.

Deborah Grady, a researcher at the University of California, San Francisco, said three in four women suffered virtually no symptoms when they stopped HRT. Most physicians recommend tapering off the pills over a period of six to 12 months rather than going cold turkey.

The researcher noted that postmenopausal women looking for alternatives to HRT are increasingly turning to low doses of antidepressants such a Prozac. Some drugs used to treat insomnia and high blood pressure have also proved effective for menopausal symptoms. The herb black cohosh is also a popular alternative.

In an effort to help women understand the risks associated with taking combination hormone-replacement therapy, the Canadian Cancer Society published a chart comparing the theoretical rates among two groups of 10,000 women, one of which takes HRT, and the other, which does not. The analysis shows that, each year: eight more women will develop invasive breast cancer (38 taking HRT, 30 not taking HRT); seven more will have heart attacks (37, 30); eight more will have strokes (29, 21); 18 more will develop blood clots in a vein (34, 16); six fewer will develop colorectal cancer (10, 16); and five fewer will suffer hip fractures (10, 15).

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