Short-term estrogen said still valuable treatment

Thursday, July 11, 2002

BOSTON -- A year or two on hormones may still make sense for millions of women beset with hot flashes and other miseries of menopause, despite worrisome new findings about long-term use of the pills.

Even though soy foods or simply avoiding caffeine may help some women, many rely on the estrogen-progestin combination to make menopausal life bearable by easing hot flashes, night sweats and sleeplessness.

A large study this week seemed to call this use into question, but several doctors said Wednesday that the benefits of hormones almost certainly outweigh the risks, especially if women stop taking the pills as soon as they can.

"We should not go into a panic and stop using estrogens altogether. They are very effective," said Dr. Isaac Schiff of Massachusetts General Hospital.

Schiff heads a task force of the American College of Obstetricians and Gynecologists that will draw up new guidelines for hormone use following the landmark study, sponsored by the National Institutes of Health.

The new research clearly shows that doctors should not prescribe the hormone combination for more than five years as a way of preventing heart disease and bone loss, something that was once routine.

Instead, it now is clear that the treatment actually begins to increase the chance of a heart attack after a year of use, even though the extra hazard is small. After four years, it begins to increase the risk of breast cancer, as well.

However, doctors say that most women entering menopause in their late 40s and early 50s have healthy hearts, so the risk of a year or two of hormone treatment for them is slight.

Unless women have unusually high risk of heart disease, "nothing much changes for the short-term use of hormones," said Dr. Wulf Utian, head of the North American Menopause Society.

Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women's Hospital in Boston, noted that for severe hot flashes, estrogen is undoubtedly the most effective treatment.

"The duration of use is really the key factor," she said.

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