MDs To HRT Patients: Don't Panic

The Early Show: Dr. Sharon Diamond
CBS/The Early Show
After last week's announcement that hormone replacement therapy does women more harm than good, doctors' offices around the country were flooded with phone calls from panicked women.

One of those doctors is Dr. Sharon Diamond of Mount Sinai Hospital, who has some suggestions for alternative treatments of menopause, osteoporosis and heart disease. She also has some words of advice for women everywhere: calm down!

One of the largest studies that has been evaluating the effects of a combination hormone replacement therapy (HRT) for women was stopped last week. The National Institutes of Health announced that a study ,known as the Women's Health Initiative and involving 16,000 women nationally, was being halted because health risks outweighed the benefits.

Half of the women in this study were taking a combination of estrogen and progestin and the other half were taking placebos. Researchers found that patients who took the therapy had small increases in breast cancer, heart attacks, strokes and blood clots in comparison to the women taking placebos. Specifically, they estimated that if 10,000 women take the combined hormone therapy for one year, eight more women than those taking dummy pills will develop invasive breast cancer, seven more will have strokes and eight more will have blood clots in their lungs.

On the benefits side, the researchers estimated that of study participants who were taking the therapy, there would be six fewer incidents of colorectal cancers and five fewer hip fractures as a result of osteoporosis.

The great thing about HRT was that it not only treated menopause symptoms, it also helped prevent osteoporosis. Until last week, patients were also led to believe the treatment helped prevent heart disease. Unfortunately, the study only recommended that women stop HRT; it did not suggest alternative treatments. Now, it seems that women will have to tackle and treat each of these things individually - no more magic cure-all.

Although it's a disappointment that HRT doesn't prevent heart disease, Dr. Diamond says all of her patients knew about the risk of breast cancer and that the percentage increase cited in the study - .08 percent - is actually less than what many doctors have been telling their patients. If women are on hormone replacement specifically to prevent heart disease, then they should stop immediately. However, most women take hormones to improve their quality of life during menopause and need to weigh the risks on a case-by-case basis. Dr. Diamond does not advocate that everyone stop taking hormones.

Alternative Treatments For Menopause
Natural menopause typically occurs between ages 48 and 55. Symptoms include but are not limited to hot flashes, night sweats, insomnia and mood swings. Doctors seem to agree that hormone replacement was THE answer to menopause woes - nothing else has proved effective.

Don't Rely On Herbs
Dr. Diamond says that the real danger in this study is that women will run in droves to their local health food store and begin taking larges doses of flax seed oil and other herbal supplements.

"I think this is like trading the devil we know for the one we don't," she says.

Because herbal formulations don't have to be approved by the FDA, their effects are not studied. No solid, reliable research suggests that such supplements are beneficial, and the negatives are completely unknown.

"We have millions of women on hormones now and we've found some complications," the doctor says. "I promise you that if millions of women turn to herbs we will see complications."

Consider Lowering Hormone Dosage
The study only examined the effects of one dosage. Dr. Diamond says that that dose is twice the amount she prescribes to any patient. She also points out that the study only looked at one combination of hormones. Other types of progesterone are available.

Try Tapering Off Hormones
The study found HRT dangerous only for women taking it over long periods of time. Dr. Diamond says that severe menopause symptoms typically only last about two years - this is considered a short amount of time to take HRT and should be perfectly safe for women. It took four years of hormone therapy for women in the study to show an increased risk of breast cancer. So, take HRT for a couple of years and then slowly cut back your dosage until you are not taking any hormones, she recommends.

Avoid Hot Flash Triggers
If you are still suffering menopause symptoms on a lower dose or after two years, or you simply want to stop taking HRT right away, Dr. Diamond suggests staying away from spicy food, alcohol and caffeine - all known to trigger hot flashes. And dress in layers so you can be as comfortable as possible when having a hot flash.

Alternative Treatments For Osteoporosis
There are other prescription medications available to treat osteoporosis so ask your doctor for alternatives. Know that none of these drugs have undergone serious study so the long-term effects are unknown, she says. All women should do weight-bearing exercise and take plenty of calcium and vitamin D.

Alternative Treatments For Heart Disease
There are a variety of medications to lower cholesterol and blood pressure. Of course, a healthy, low-fat diet is always a good idea.