With unprecedented numbers of Canadian women about to enter menopause, Canadian
doctors are telling women it's safe to go back on hormones.
An expert panel convened by the Society of Obstetricians and Gynecologists of
Canada has concluded that no treatment is as effective as hormone therapy for
hot flashes and other symptoms of menopause.
The group says an "extensive" review of new data -- along with a re-analysis of
a massive study that led women to abandon hormones in droves seven years ago --
shows hormones are a safe option for moderate to severe symptoms, if started
early and used over the short term.
The group is recommending using the lowest effective dose. And while there is no
fixed timeline, they suggest taking it for "four to five years is a good
starting point," said Dr. Robert Reid, lead author of the updated guidelines and
chairman of the division of reproductive endocrinology and infertility at
Queen's University.
"A lot of women were told point-blank, 'Stop your hormones. Suck it up.' And
they're in my office with terrible hot flashes and irritability and depression
and other mood things, and they're saying, 'My doctor won't prescribe (hormones)
for me,' " Dr. Reid said. "What we're trying to do is ensure people who have
symptoms that may benefit aren't afraid to put (hormones) on the list of
options."
This year, the largest demographic from the Baby Boomer generation turns 50. In
Canada, there are now 2.5 million women between 45 and 54.
Women are expecting treatments will be provided to them, Dr. Reid said.
Women and their doctors were frightened off hormones after a run of troubling
news from one of the largest and most expensive studies ever conducted by the
U.S. National Institutes of Health.
The Women's Health Initiative Trial, which involved nearly 17,000 women, was
prematurely halted in 2002 after researchers discovered an increased risk of
heart disease, strokes, breast cancer and blood clots in women using an
estrogen-progestin combination.
In Canada, hormone prescriptions plummeted, from 11.6 million in 2002 to five
million in 2007, and down further to 4.8 million in 2008, according to IMS
Health Canada, a firm that tracks prescription-drug use.
Many doctors told women to go off hormones and to try losing weight. They were
advised to use fans or cold face cloths for hot flashes. The hormone backlash
helped fuel a multi-billion-dollar market for alternative products, with scant
safety data or evidence of benefit, doctors say.
But a second look at the data found no increases in risk for coronary heart
disease in younger women aged 50 to 59.
Dr. Michel Fortier, professor of obstetrics and gynecology at the University of
Laval, said the No. 1 fear of using hormones is breast cancer. But, he says,
"women take a much greater risk by getting into a car to (drive to) my office
than taking HT (hormone therapy)."
The Canadian update says longer-term use (more than five years) increases the
risk of breast cancer, but the risk is similar to the risk a woman runs by being
overweight, drinking alcohol every day or not exercising.
The risk returns to normal after hormones are stopped.
Dr. Reid said herbal and natural health products can interact with prescription
drugs and anesthetics.
"We are now telling our members not to be sending a woman to the drugstore to
find a herbal remedy for her hot flashes," Dr. Reid said.
