The murky picture of whether post-menopausal women ought to take hormone replacement therapy may just have become murkier. The Canadian Cancer Society issued a position statement on the once-popular drugs yesterday, urging women to avoid using combination HRT if they can help it.
The society suggested women not take combined estrogen-progestin therapy unless they are suffering severe menopausal symptoms that have not responded to any other form of treatment. It recommend trying exercise, relaxation techniques and vitamin E supplements first.
“Our position is that women avoid combination HRT, because of the breast cancer risk,” said Heather Logan, director of cancer control policy.
“I believe it’s a step beyond where the market is right now.”
The definitiveness of that statement worried some clinicians who daily face the confusion that has swirled around the issue since July 2002, when a large, long-term U.S. study of HRT was ended early because it became clear the risks of the drugs outweighed the benefits.
“Women are going nuts, they really are,” said Dr. Sandy Messner, medical co-ordinator of the clinical breast cancer prevention services at Sunnybrook and Women’s College Health Sciences Centre in Toronto.
“I have so many patients who really should be on hormones who are terrified to take it now because of all this media stuff.”
An official with the Society of Obstetricians and Gynecologists cautioned there is no cut-and-dried rule when it comes to HRT.
“The Canadian Cancer Society does not address the fact that it’s not a black and white situation of ‘you take’ or ‘you don’t take,’ ” said Dr. Vyta Senikas, associate executive vice-president of the organization, which advises that short-term use under four years of hormones is safe and effective for the relief of menopausal symptoms.
“At the end of the day it’s the patient who uses the product. It’s the patient who has to make up her mind.”
For years, combined HRT was commonly prescribed to women with an intact uterus not just for the relief of menopausal symptoms, but on the assumption it slowed other irritants of aging, and protected against heart disease, osteoporosis and dementia.
But all that changed with the release of the first data from the Women’s Health Initiative. The study, which was to continue until 2005, was halted when it became clear that not only did HRT raise the risk of breast cancer which had been known but it also increased the risk of heart attack, stroke and blood clots.
A second arm of the study looking at estrogen-only HRT given only to women who have undergone a hysterectomy continues. It is scheduled to conclude in 2005.
None of the findings from the combined therapy arm can be applied to estrogen-only HRT, but nonetheless even women on this form of the drug are expressing reservations about hormone replacement, Messner said.
“All women are becoming afraid to use it.”
Messner has no problem with the idea that women should try other options. But she believes that for women suffering severe symptoms of menopause, combined HRT in the smallest dose possible makes a huge difference to quality of life.
“You should avoid it unless you have a good reason to take it. But I think what happens is people stop at the ‘you should avoid it’ part (of the message) and they don’t think anymore about there being good reasons to take it,” she said.
“It’s the best thing we have to treat symptoms.”
The cancer society said its advice was based on the admittedly small but real increased risk that women on HRT will develop breast cancer.