Putting HRT risks into perspective

Putting HRT risks into perspective
Should a woman take hormone therapy (HT) even if there is the slightest chance of an increased health risk or side effect? Should she swear off all HT even if it means relief from troublesome menopausal symptoms? It is important to put into perspective the health benefits and risk based on a woman’s individual menopausal symptoms, health history, and treatment preferences.

Dr. Margery Gass, Executive Director for the North American Menopause Society understands the challenges women face in deciding whether to take HT. She offers advice to deal with the enormous amount of information surrounding HT.

Dr. Gass: ‘I think it’s a patient’s right to refuse therapies that they don’t want to take. We certainly can tell them these risks are low for example the risk of blood clots with HT is the same as the risk of blood clots with hormonal contraception or oral contraceptive pills.

So if that helps women to put that risk in perspective we know that most women don’t refuse to take oral contraceptives even though there is a small risk of blood clots. Helping to put the risk in perspective is important because each woman is different in terms of tolerance and health history.

There are risks associated with aspirin, you could have Gastro Intestinal (GI) bleeding, or ulcers but you might decide that aspirin for your headache is worth the small risk of the GI bleed.’

I asked Dr. Gass what could help women determine their need for HT.

Dr. Gass: ‘The main thing would be whether women find their menopausal symptoms disruptive in their lives and bothersome to the point of affecting quality of life. Anybody who feels the symptoms are a big nuisance in their life I think should talk to their clinician about getting HT if they are an appropriate candidate. I stress that being an appropriate candidate is very important. We are not eager to give them to a woman who has already had a blood clot, because she is probably at a high risk for another one.

So some people probably would be better off not taking hormones. But for the vast majority of women who are healthy, hormones are a perfectly fine option And it’s up to her to make the call about whether or not she’s tired of dealing with those menopausal symptoms and would like something more substantial to for menopause management.'

I asked Dr. Gass about the possible fallout from studies such as the 2001 WHI and the increased risks of developing breast cancer. The word cancer tends to put fear into many people.

Dr. Gass: ‘That’s where people’s priorities come in. I was always amazed seeing patients come in the door talking about hormones and some of them would say well based on what I read about hormones... And then I could never bet on which way it could go. Some of my patients would say of course I’d take hormones and get all that relief from hot flashes and from genital dryness; of course I would who wouldn’t? But the next person would come in and say based on what I’ve read, of course I wouldn’t take hormones, I don’t want any kind of increased risk of breast cancer.

So people seem to have their own priority list of what matters to them. And as healthcare providers, we can respect that and we can try to put things in perspective for each woman. For example in terms of the concern about breast cancer, one of the ways to look at this is that your risk of getting breast cancer if you use HT for the year is about what it would be for your friend who still hasn’t had menopause, or even for yourself without taking HT. So it’s the same kind of risk as having your menopause delayed another year; it is not always a clear-cut predictive indicator.

‘The problem for all of us is that none of us can guarantee that somebody’s not going to have a side effect of something. You might choose not to take hormones and two years later you get breast cancer anyway; another woman may get breast cancer after taking hormones. You can’t tell which is the person who got the ‘extra’ risk of breast cancer compared to who is the person who would have gotten it anyway.’

Putting the risks and benefits into perspective helps sort of the facts and helps women make more informed decisions.

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