New hormone replacement therapy study

Throttle Up

Wouldn’t you love to be able to reach through your television screen and throttle some of those experts, pundits, authorities, consultants, analysts, etc., who spout foolishness with the greatest of ease?

I’d pay big money for a TV set like that.

And it would have come in handy the other day when I saw a program with a panel of medical experts discussing the latest hormone replacement study (HRT) published last week in the Archives of Internal Medicine. The panel included a woman who is suffering from many menopausal symptoms, but refuses to take HRT.

A doctor on the panel – a man with a very friendly demeanor – suggested that her fear wasn’t a “direct fear,” only a “possible fear.” I’m paraphrasing here, but his clear implication was this: If you’re not at high risk of developing one of HRT’s negative side effects, then your fear of HRT is like the fear of the boogeyman; it’s all in your head. The actual risk is very small.

If this comment had come from a woman, my urge to throttle would have possibly been diminished. Possibly. But when a man casually suggests that the risks shouldn’t worry our pretty little heads I have only one word: Grrrrrr!

I actually have a few other words, but they’re unprintable here.

Go to the source? No thanks

Conjugated equine estrogen (CEE) is the generic name of a pharmaceutical mix of several estrogens derived from the urine of pregnant mares. Lovely. The brand name is Premarin (PREgnant MARe urIN), but it can only be taken by women who have had hysterectomies because it creates a high risk of uterine cancer.

This therapy addresses menopausal symptoms – such as hot flashes, sleep disorders and vaginal dryness – that affect quality of life. But the side effects of this treatment involve quality of life factors as well.

According to MedicineNet.com, some of the most common CEE side effects include headache, nausea, back pain, joint pain, vaginal bleeding, loss of periods or excessively long periods, breast pain, rashes and facial blemishes that may persist even after the therapy is discontinued.

Gee, I wish there was a TV doctor available who could tell me if my fear of these unpleasant effects qualifies is a “direct fear” or just a “possible fear.”

It’s a push

For this latest HRT study, a team of Women’s Health Initiative (WHI) researchers investigated how health-related quality of life factors might be affected by CEE use. They examined records of more than 10,000 women who participated in the WHI study of CEE. (As you may recall, this study was abruptly shut down in 2002 when it became apparent that the treatment increased the risk of stroke. A later study also found that CEE users might have a higher risk of dementia.)

Six specific quality of life measures were assessed with questionnaires given before the treatment started, and again one year later. A subgroup of more than 1,000 subjects completed an additional questionnaire three years after the study began.

Results showed that CEE did not produce a “clinically meaningful effect” on quality of life. Women who received CEE reported a “statistically significant but small” reduction in sleep problems. But they also reported a “statistically significant but small” NEGATIVE effect on social functioning.

In other quality of life measures – such as vitality, pain, depression, cognitive function and sexual satisfaction – there was no change at one year. Similar results were recorded in the subgroup after three years.

So given all the potential side effects – both large and small – why in the world would a woman want to use this treatment? Would you really want to risk all those side effects on the off chance that you might enjoy a small improvement in sleep dysfunction?

I wonder, would the hope of getting a slightly better night’s sleep be considered a “direct hope” or just a “possible hope”?

Sources:
“Effects of Conjugated Equine Estrogen on Health-Related Quality of Life in Postmenopausal Women With Hysterectomy” Archives of Internal Medicine, Vol. 165, No. 17, 9/26/05, archinte.ama-assn.org
“Estrogen Not Effective After Menopause” Lindsey Tanner, Associated Press, 9/26/05, newsday.com