Hormone therapy gets a go

The pendulum has swung the other way again. Hormone-replacement therapy is back on the books as a recommended treatment for moderate to severe symptoms of menopause.

HRT has been wrapped in controversy since the Women’s Health Initiative (WHI) study in the U.S. halted its examination of the therapy as a preventive measure against heart disease and other chronic illnesses of aging after results indicated an increased risk of breast cancer.

But now the Society of Obstetricians and Gynecologists of Canada, in the first update of its guidelines since 2001, has endorsed HRT to treat some menopausal symptoms.

It wasn’t a difficult decision, says Dr. Vyta Senikas, associate executive vice-president of the society and member of the committee working on the guidelines, which sifted through literature from various studies to come up with the most appropriate treatment recommendations.. "The science is what it is."

The results of the WHI study were not particularly relevant to women using HRT as a therapy during menopausal and peri-menopausal years for symptoms such as hot flashes, says Senikas. It was looking at long-term use for prevention and with an older population.

 "In science what you cannot do is take the outcome of one study of a population group for an objective and apply it to another population group for a secondary objective, " she says. "It (WHI) was looking at heart disease as a primary objective, while the the perimenopausal and menopausal group the issue of symptomology is the prime concern."

She adds that the average age of patients in the study was 66 and they were on long-term use of the therapy, while the average age of menopausal women using HRT is 51 and they are usually on it for a short time only, until the symptoms abate. As well, patients who were symptomatic for menopause were specifically excluded from the WHI study.

So it was really comparing apples and oranges, Senikas says, adding that gynecologists understood that but women and their family physicians were confused by the information.

"One of our biggest concerns was to ensure that family doctors has the most up-to-date information. It’s easier among specialists; that’s all they have to look at. But a family doctor has much more to focus on."

Another concern, she adds, is that women who became uncomfortable with the hormone treatments were turning to natural remedies, which may be no safer. "Just because it’s natural doesn’t mean it may not have long-term implications," she maintains. "There’s no science behind these (natural) therapies and even the ones that seem to show promise may carry the same risks at the end of the day, because estrogens are estrogens."

"When they retire, the heart health crunch may become a heart health crisis," said Toronto cardiologist Dr. Beth Abramson in a report news release.

Epidemiologist Corinne Hodgson says boomers seem to have "rose-coloured glasses on. "They are planning exotic retirement travel and on having the time of their lives," she said. "But you are not going to be travelling and having the time of your life in the ICU waiting for your bypass; that's going to be a crimp in your style."

What’s the answer? Prevention, says the heart and stroke foundation.

"It’s never too late. No matter what your age, increasing activity, quitting smoking and losing weight — even modest weight loss — can reduce your blood pressure, blood glucose and blood cholesterol," Abramson says. "This can go a long way to reducing risk of developing heart disease and stroke, and give many more years of healthy active life."