Hawai'i doctors consider hormone alternatives
By Beverly Creamer
Advertiser Staff Writer
The phones are ringing in the offices of Hawai'i doctors as post-menopausal women look for answers in the wake of a troubling report that widely used hormone replacement therapy increases the risk of breast cancer, heart attack and stroke.
Deborah Booker • The Honolulu Advertiser
"I don't want anyone to panic," said Dr. Santosh Sharma, a Honolulu obstetrician-gynecologist who has been co-investigator for the study in Hawai'i, which included 265 women. "It's not a substantial increased risk, but I encourage people to go to their own doctor and talk about the risks."
Dr. Laura Hoque, left, examines breast X-rays with patient Leslie Hayashi at the Kapi'olani Women's Center. Hayashi recently gave up hormone replacement therapy because of concerns over long-term effects.
Leslie Hayashi did just that, visiting the Kapi'olani Breast Center run by Dr. Laura Hoque, medical director of the Kapi'olani Wom-
en's Center and a surgeon who specializes in treatment of breast cancer. Hayashi, 56, had been on hormone replacement therapy for seven years although she voluntarily stopped more than a year ago because of concerns about long-term effects.
"For me it became almost a subconscious emotional issue," said Hayashi, a self-employed advertising writer. "I stopped feeling confident taking hormones was the best thing for me."
The new data exploded what some called "the magic bullet, one-size-fits-all" myth of hormone replacement therapy — known as HRT — as an antidote to everything from the symptoms and concerns of menopause to worries about heart disease and fragile bones.
The Women's Health Initiative, the largest study ever conducted in the United States of women's midlife health issues, set out to study the effects of HRT nine years ago. The University of Hawai'i John A. Burns School of Medicine is one of 46 participating sites.
The study found that women taking estrogen and progestin had a slightly higher occurrence of breast cancer, heart attacks and strokes than those who took a placebo containing only sugar.
"It's a big blow, and there's going to be an emotional reaction women are going to have with the menopause security blanket taken away," said psychologist Jennifer Hays, a principal investigator for the study at Baylor College of Medicine in Houston, one of the country's largest study sites.
The results of the National Institutes of Health study, which will be published in the July 17 issue of the Journal of the American Medical Association, are available online.
The issue of emotional well-being brought about by hormones may be an especially difficult one for many women. Hoque, for instance, said that "sexuality is enhanced big time" by hormone replacement therapy, and that women on hormones simply feel better, although data on this area of the study has not yet been analyzed.
Hayashi, for instance, began hormone replacement at 47, not out of concerns about heart disease or hot flashes, but because of an overwhelming sense of depression.
"Within a week and a half on the Premarin I felt terrific again," she said. "They tell you don't take hormones for emotional reasons, but it worked for me. When I stopped I was apprehensive. But I'm OK."
As women on hormones seek their physicians' advice on risk/benefit options, Sharma warns patients not to stop suddenly taking medication without consulting their doctors. It could bring back hot flashes, or cause unexpected bleeding, she said.
And doctors, for their part, are already pointing to a wide variety of existing options to handle the medical issues of menopause.
Dr. Jennifer Frank, a Honolulu general practitioner, said her patients have been making other choices for menopause health issues because of the long-time concern about HRT's potential role in encouraging breast cancer.
"You can also treat hot flashes with other things, such as clonidine, a blood pressure pill," Frank said. "Sometimes being on a low dose of an anti-depressant also helps with hot flashes. I have people who had already switched to estrogen-only pills and they have an annual ultrasound of the pelvis just to check for cancer."
Estrogen alone carries an increased risk of uterine cancer for women who have not had hysterectomies. However, an estrogen-only component of the study for women with hysterectomies will continue. There are no indications of increased breast cancer risk in this group such as has now been found in the group using a combination of estrogen and progestin.
Reach Beverly Creamer at 525-8013 or creamer@honoluluadvertiser.com.
