Menopausal Health, Hormone Replacement Therapy

This Q&A was created by Dr. Andrew Goldstein, recounting the types of questions he is being asked in his gynecological practice in the aftermath of the Women's Health Initiative (WHI) study evaluating combined estrogen and progestin use in postmenopausal women was halted.

Should I stop taking hormone replacement therapy?
Despite the information that was in the press recently, that is not an easy question, and all decisions should be made in consultation with your health care provider. In order to make your decision you should consider your individual risk of the following conditions based on your health history and your family history: Cardiovascular disease, stroke, breast cancer, colon cancer, osteoporosis, Alzheimer's disease and macular degeneration.

Is it dangerous to abruptly stop HRT? Must I wean myself off HRT? Will I bleed if I stop taking my Prempro?
It is not dangerous to just stop your HRT. You may get some minimal bleeding if you stop HRT, but that is not dangerous. Your menopausal symptoms such as hot flashes may return if you stop HRT.

If I am just on Premarin, does this new information apply to me?
No, the part of the WHI study that was stopped was for women on a combination of Premarin and Provera (medroxyprogesterone) called Prempro. The doctors who are running the study did not stop it for women who take Premarin alone.

Are there any alternatives to HRT?
Absolutely, but it depends on what symptoms you are treating or what diseases you are trying to prevent. There are multiple herbal supplements that have been found to help against hot flashes, such as black cohash. There are excellent medications for the prevention and treatment of osteoporosis. There are estrogen medications that can be applied just to the vagina that help treat vaginal dryness. Exercise and diet can also go along way to prevent the side effects of menopause. You should talk to your doctor about your symptoms and the options available to you.

I feel panic stricken, I have been on Prempro for ten years. Am I going to get cancer?
Please recognize that while this study showed a 26% increase in the chance of a woman getting breast cancer, that is far different than saying that a woman who takes Prempro has a 26% certainty of getting breast cancer. In fact, of the more than 8000 women who took Prempro 290 developed breast cancer. Of the 8000 women who did not take Prempro, 230 developed breast cancer. Lastly, the Prempro prevented 23 women from getting colon cancer.

Call your health care professional and discuss your case.

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