July 10, 2002

The National Institute of Health has undertaken the Women’s Health Initiative to answer questions regarding the use of estrogen and progestins in women who are past menopause. Recently, the study group announced that they are stopping the arm of the study that involved the use of conjugated estrogens and medroxyprogesterone acetate-otherwise known as Prempro. The reason for this involves breast cancer risk. The study confirmed that women taking the combination of hormones were at greater risk. This amounted to an increased risk of 26% in this group of women. The study also concluded that the risk of stroke, heart attack and blood clots was also increased. The risk of bone fracture and colon cancer was decreased, but these investigators felt that it was not enough to support the continued use of this estrogen and progesterone combination. These are all known complications of estrogen replacement therapy. This study however, defines these risks much more clearly. Only 2.5% of women in the study had these negative events. In 10,000 women: 7 additional women will have a heart attack, 8 additional women a stroke, 8 additional breast cancers and 18 additional blood clots as compared to the placebo group. The death rate in the placebo group and the estrogen/progestin group was the same.

What to do.

If you are on the combination of conjugated equine estrogens and medroxyprogesterone acetate (Prempro), and you wish to stop, you may simply stop the medication. Most women will experience no effects. Some women will have the return of hot flashes and occasionally some women experience minimal vaginal bleeding. Alternatively, you could switch to a different hormonal combination. WomanCare is sponsoring seminars to fully update you on the implications of this study. If you do not wish to discontinue your hormone replacement therapy, but have questions, please feel free to attend one of our seminars or make an appointment to speak with your physician. Once again, it is important to realize that the information is not new but is more definitive and may cause you to re-evaluate your medications. We are here to help you through that process. Unfortunately, the press has sensationalized the coverage of this topic and unduly frightened many women.

If you are on another estrogen therapy, the data are not at all clear. You may elect to continue the therapy and follow-up with your own doctor or stop it altogether. This one study has recommended that the group on combined hormones described above stop them. They are, however, encouraging women in other arms of the study to continue the therapy.

WomanCare P.C.