Trying to ease the anxiety over hormone drugs

By Beverly Creamer and Tanya Bricking
Advertiser Staff Writers

Effects of estrogen replacement therapy (click for graphic) Advertiser photo illustration Answers for your questions on hormones Do you have more questions for the experts? Whether you're concerned about hot flashes or heart disease, The Honolulu Advertiser's panel of doctors and naturopaths will take on some of your questions this week. E-mail your questions to islandlife@honoluluadvertiser.com, and the panel's answers will be published next Sunday in this section.

These are some of the questions being heard in doctor's offices here and across the country as women reassess hormone replacement therapy in the wake of startling reports that long-term use of the therapy can increase the risk of breast cancer and heart disease.

Doctors in Hawai'i are taking the news seriously. But they don't want patients to panic. As they emphasize, every woman has an individual medical profile and needs to make choices based on that.

A nationwide study shows that the statistical risk for breast cancer and heart attack increases with prolonged use of high-dose estrogen and progestin after menopause. However, Dr. David Curb, principal investigator for the hormone replacement therapy study in Hawai'i, notes that increased risk for any one woman taking hormones is still low.

"It's not like you have to rush out and quit tomorrow and purge them from your system," he said. "There may be women in which the symptoms and other things are such a problem that they would be willing to take the risk."

In other words, there's no one-size-fits-all answer.

"There's a lot of data, and it's really an individual decision each patient is going to make with her provider," said Dr. Christian Sunoo, assistant chief of obstetrics and gynecology at Kaiser Permanente. "Generalizations rarely apply to everybody."

"This is not something you can give a blanket statement about," agreed Dr. Jennifer Frank, a family-practice physician who has been helping patients weigh the issues.

"Some (women) are quitting," Frank said. "And for some, the emotional factor is influencing them to stay on. They feel better on (hormones). And if they can assess the risks and look at them and feel like those are tolerable, they're staying on."

There are many factors to consider. Hormone therapy increases risk for breast cancer and heart disease. Some women must balance that against evidence the therapy reduces risk for colon cancer, osteoporosis and Alzheimer's.

Decisions also are being weighed over quality-of-life concerns such as mood swings, hot flashes, and a general sense of well-being.

To help women make decisions, The Advertiser asked a number of physicians, including obstetricians, a breast specialist, heart specialist, family practitioner, reproductive endocrinologist, menopause expert, naturopath, and a nutritionist to offer advice. Regardless of their suggestions, they all say a woman's best first move is to speak to her doctor.

Beyond that, they have a wealth of ideas about alternatives to hormones — everything from antidepressants to acupuncture and common-sense health tips.

"I always ask my patients, 'What are you most afraid of?'" said Dr. Fredric Pashkow, medical director of the Heart Institute at The Queen's Medical Center and author of "The Women's Heart Book: The Complete Guide to Keeping Your Heart Healthy and What To Do If Things Go Wrong." "Since we don't have all the answers, tell me what you're most afraid of and we'll manage the situation accordingly."

You can reach Beverly Creamer at bcreamer@honoluluadvertiser.com or 525-8013. You can reach Tanya Bricking at tbricking@honoluluadvertiser.com or 525-8026.