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Study showed dangers of taking estrogen

The medical world and menopausal women were shocked last month by news that estrogen, touted as an elixir of youth and health, caused a significant increase in breast cancer, heart disease and blood clots in a combination pill called Prempro (Premarin plus Provera).

For years, women had been told by doctors that taking estrogen-progestin (such as Prempro) would not only ease hot flashes, insomnia, moodiness and depression, but would help prevent osteoporosis, heart disease and mental deterioration. Forty years of studies, however, showed conflicting results and the specter of breast, uterine and ovarian cancer hovered as a possible risk of taking hormones.

Now a definitive study has put much of this confusion to rest. The Women’s Health Initiative is a 15-year, multimillion dollar study involving 162,000 women ages 50 to79, conducted by the National Institutes of Health. One part is a randomized controlled clinical trial, considered the strongest design to get clear results about treatments.



Two subgroups of about 16,000 women each entered the hormone replacement therapy trial. Those with a uterus took Prempro or a placebo (sugar pill); those who had had a hysterectomy took Premarin or a placebo. A computer randomly assigned real pills or sugar pills to make each group similar.

The HRT clinical trial was supposed to last eight to12 years. But after only five years, the NIH called a halt to the Prempro group (the Premarin group continues).




The reason? A startling result: the women taking Prempro – compared to a placebo – had a 41 percent increase in strokes, a 29 percent increase in heart attacks, a 26 percent increase in breast cancer and a 100 percent increase in blood clots.

While there were some benefits (the Prempro women had a 37 percent reduction in colorectal cancer and a 33 percent reduction in hip fractures), NIH investigators did not feel these benefits outweighed the risks. They therefore announced to the medical community that no woman should start or continue to take Prempro for reducing heart disease or preventing colorectal cancer. They were undecided about using it to prevent osteoporosis.

While it is now clear that this hormone combination is dangerous when taken more than four to five years, we still do not know about other forms of estrogen and progestins (or progesterone, for that matter). WHI is gathering data about which hormones the 100,000 other women are using and will determine if these cause increased heart attack and cancer risks. Results from this part of the study are expected in 2007.

In addition, WHI is looking at the effects of a low-fat diet emphasizing fruit, vegetables and whole grains on heart disease, and whether calcium and vitamin D supplements will prevent fractures from osteoporosis. These results will also be out in 2007.

What can women do?

Educate yourself. Not all hormones, for instance, are the same. Premarin, for example, is made from pregnant mare’s urine, a very strong group of estrogen compounds with progestins and androgens (male hormones) included. Provera is a synthetic substance, created in the chemistry lab, called progestin. While it has many properties of natural progesterone, it is much stronger and harsher.

There is, however, a new generation of human identical hormones. These are made from soy, have the same molecular structure as women’s own hormones, and don’t seem to cause the side effects of the other hormones. They go under such names as estradiol (Estrace, various patches, creams) or compounded estrogens plus micronized progesterone (Prometrium, creams).

Your health practitioner should know about these. Discuss them with him or her. Given the results of the WIH study, many practitioners are now phasing their patients off Premarin or Prempro (quitting cold turkey can throw you back into severe menopause symptoms).

Some practitioners are even recommending such alternatives as herbs (black cohosh and vitex), vitamin E and primrose oil to help alleviate symptoms. Often these are started when the hormone phase-off begins.

And some women, whose menopause symptoms are mild, have chosen to take nothing at all.

Lennie Martin and Pam Jung teach alternative approaches to dealing with menopause. Contact them at The Union, 464 Sutton Way, 95945.


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