|
Facts About Postmenopausal Hormone
Therapy
NOTE: Since this fact sheet was written in October 2002, a development
has occurred that may affect your health decisions. The National Institutes of Health stopped the estrogen-alone study of the Women's Health Initiative (WHI).
Choosing whether or not to use postmenopausal hormone
therapy can be one of the most important health decisions women face as they
age. As with taking any treatment, the decision involves carefully weighing the
risks and benefits involved.
But, until recently, the picture of those risks and benefits
has been unclear. Studies gave conflicting results about the therapy's effects
on breast cancer, heart disease, and other conditions.
Box 1 |
Oral Estrogen and Estrogen/Progestin
Products* |
Estrogen pills: |
Premarin |
conjugated equine estrogens |
Cenestin |
synthetic conjugated
estrogens |
Estratab |
esterified estrogens |
Menest |
esterified estrogens |
Ortho-Est |
estropipate (piperazine estrone
sulfate) |
Ogen |
estropipate (piperazine estrone
sulfate) |
Estrace |
micronized 17-beta-estradiol |
Progestin pills: |
Amen |
medroxyprogesterone acetate |
Cycrin |
medroxyprogesterone acetate |
Provera |
medroxyprogesterone acetate |
Micronor |
norethindrone |
Nor-QD |
norethindrone |
Aygestin |
norethindrone acetate |
Ovrette |
norgestrel |
Norplant |
levonorgestrel |
Prometrium |
progesterone USP (in peanut
oil) |
Megace |
megestrol acetate (not for uterine
protection) |
Estrogen plus progestin
pills: |
Premphase |
conjugated equine estrogens and
medroxyprogesterone acetate |
Prempro |
conjugated equine estrogens and
medroxyprogesterone acetate |
Femhrt |
ethinylestradiol and norethindrone
acetate |
Activella |
17-beta-estradiol and norethindrone
ecetate |
Ortho-Prefest |
17-beta-estradiol and
norgestimate |
* As of Fall 2000
|
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In the summer of 2002, new findings emerged that have
finally begun to fill in some of the picture's details. While much more remains
to be learned, the findings offer women some guidance about the risks and
benefits of using postmenopausal hormone therapy.
This fact sheet discusses those findings and gives you an
overview of such topics as menopause, hormone therapy, and alternative
treatments to the symptoms of menopause and various health risks that come in
its wake. It also provides a list of sources you can contact for more
information.
If you're on hormone therapywhether short- or
long-term useyou're bound to have a lot of concerns. This fact sheet will
provide some information, but it's important to talk with your doctor or other
health care provider about your health profile. Being informed is one of the
best ways you can protect your health.
Box 2 |
Gels, Creams, Patches, and Other Hormone
Products* |
Estrogen products: |
Cream |
Estrace |
micronized 17-beta-estradiol |
|
Ortho Dienestrol |
dienestrol |
|
Premarin |
conjugated equine estrogens |
Vaginal Tablet |
Vagifem |
estradiol hemihydrate |
Vaginal Ring |
Estring |
micronized 17-beta-estradiol |
Skin Patch |
Alora |
micronized 17-beta-estradiol |
|
Climara |
micronized 17-beta-estradiol |
|
Esclim |
micronized 17-beta-estradiol |
|
Estraderm |
micronized 17-beta-estradiol |
|
Vivelle |
micronized 17-beta-estradiol |
|
Vivelle-Dot |
micronized 17-beta-estradiol |
Progestin products: |
Vaginal Gel |
Crinone |
progesterone |
Injection |
Depo-Provera |
medroxyprogesterone acetate (not for
uterine protection) |
IUD |
Mirena |
levonorgestrel |
|
Progestasert |
progesterone |
Estrogen plus progestin
products: |
Skin Patch |
Combipatch |
17-beta-estradiol and norethindrone
acetate |
Ortho-Prefest |
17-beta-estradiol and norgestimate
|
Injection |
Depo-Testadiol |
testosterone and estradiol
cypionate |
* As of Fall 2000
|
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Menopause and Hormone Therapy
As you age, significant internal changes take place that
affect your production of the two female hormones, estrogen and progesterone.
The hormones, which are important in regulating the menstrual cycle and having
a successful pregnancy, are produced by the ovaries, two small, oval-shaped
organs.
During the years just before menopause, known as
perimenopause, your ovaries begin to shrink. Levels of estrogen and
progesterone fluctuate as your ovaries try to keep up production of the
hormones. You can have irregular menstrual cycles, along with unpredictable
episodes of heavy bleeding during a period. Perimenopause usually lasts several
years.
Eventually, your periods stop. Menopause marks the time
of your last menstrual period. It is not considered the last until you have
been period-free for 1 year without being ill, pregnant, breast-feeding, or
using certain medicines, all of which also can cause menstrual cycles to cease.
There should be no bleeding, even spotting, during that year. Natural menopause
usually happens sometime between the ages of 45 and 54.
You also can undergo menopause as the result of surgery. A
surgical procedure, called a hysterectomy, removes the uterus and sometimes the
ovaries and fallopian tubes as well. You go through menopause if both of your
ovaries are removed. Otherwise, the surgery does not affect menopause, which
still occurs naturally.
Whether you go through menopause naturally or surgically,
symptoms can result as your body tries to adjust to the drop in estrogen
levels. These symptoms vary greatlyone woman may breeze through menopause
with few symptoms, while another has difficulty. Symptoms may last for several
months or years, or persist. The most common symptoms are hot flashes or
flushes, sweats, and sleep disturbances. (A hot flash is a feeling of heat in
your face and upper body, which may cause the skin to appear flushed or red as
blood vessels expand. Hot flashes that occur with severe sweating during sleep are called night sweats.) But the drop in estrogen also can contribute to other
symptoms, such as changes in the vaginal and urinary tracts, which can cause
painful intercourse, urinary infections, and the need to urinate more often.
Box 3 |
Hormone Therapy Schedules
- Cyclic or sequentialEstrogen for 25 or 30
days a month, with progestin added for 10-14 days
- Continuous-combinedEstrogen and progestin
daily
|
To relieve the symptoms of menopause, doctors may prescribe
postmenopausal hormone therapy. This can involve the use of either estrogen
alone or with another hormone called progesterone, or progestin in its
synthetic form. The two hormones normally help to regulate a woman's menstrual
cycle. Progestin is added to estrogen to prevent the overgrowth (or
hyperplasia) of cells in the lining of the uterus. This overgrowth can lead to
uterine cancer. If you haven't had a hysterectomy, you'll receive estrogen plus
progestin therapy; if you have had a hysterectomy, you'll receive estrogen-only
therapy. Hormones may be taken daily (continuous use) or on only certain days
of the month (cyclic use).
They also can be taken in several ways, including orally,
through a patch on the skin, as a cream or gel, or with an intrauterine device
(IUD) or vaginal ring. How the therapy is taken can depend on its purpose. For
instance, a vaginal estrogen ring or cream can ease vaginal dryness, urinary
leakage, or vaginal or urinary infections, but does not relieve hot flashes.
Hormone therapy may cause side effects, such as bleeding,
bloating, breast tenderness or enlargement, headaches, mood changes, and
nausea. Further, side effects vary by how the hormone is taken. For instance, a
patch may cause irritation at the site where it's applied.
Box 1, Box 2, and
Box 3 list products and schedules for various hormone
therapies. There also are nonhormonal approaches to easing the symptoms of
menopause. Box 4 offers a list of some of these
alternatives.
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Box 4 |
Alternatives to Hormone Therapy to Help Prevent
Postmenopausal Conditions and Relieve Menopausal Symptoms
You may want to consider alternatives
to hormone therapy to ease menopausal symptoms. The list below includes some
locally applied hormone products (which may not carry the same risks as those
that deliver medication throughout the body), dietary supplements, and
lifestyle measures. Talk with your doctor or other health care provider about
the best treatment for you for each symptom.
Be aware that, unlike drugs, the U.S.
Food and Drug Administration (FDA) does not have the authority to approve
dietary supplements before they are sold. The dietary supplement manufacturer
is responsible for insuring that the product is safe and that any
representations or claims made about it are adequately substantiated and not
false or misleading (see Box 5).
One positive move you can make to feel
better is to adopt a healthy lifestyledon't smoke, eat a variety of foods
low in saturated fat and cholesterol and moderate in total fat, maintain a
healthy weight, and be physically active.
For postmenopausal conditions:
Osteoporosis
- See Box 20 for lifestyle
behaviors to protect bone density
- Designer estrogen Raloxifene (Evista), which
preserves bone density
- Bisphosphonates Actonel or Fosamax, which reverse
bone loss and prevent fractures
- Calcitonin (a nasal spray), which may prevent
fractures
- Note: Phytoestrogens (see "Hot flashes" below) have
not been shown to reduce fractures
Heart disease
- Lifestyle behaviors, including:
- Following a healthy eating plan
- Limiting consumption of alcoholic beverages
- Not smoking
- Maintaining a healthy weight
- Being physically active
- Preventing and controlling high blood pressure
- Preventing and controlling high blood cholesterol
- Managing diabetes
- Taking prescribed medication to control heart
disease
For menopausal symptoms:
Hot flashes
- Lifestyle changes. These include dressing
and eating to avoid being too warm, sleeping in a cool room, and reducing
stress. Avoid spicy foods and caffeine. Try deep breathing and stress reduction
techniques, including meditation and other relaxation methods.
- Soy. This contains phytoestrogens.
(Phytoestrogens are estrogen-like substances derived from a plant source.)
However, there is no solid evidence that soyor other sources of
phytoestrogensreally do relieve hot flashes. Further, the risks of taking
soy, especially the more concentrated forms of soy, such as pills and powders,
are not known. Phytoestrogens from soy can be consumed through foods or
supplements. Soy food products include tofu, tempeh, soy milk, and soy nuts.
These soy products are more likely to work on mild hot flashes.
- Other sources of phytoestrogens. These
include such herbs as black cohosh, a member of the buttercup family, wild yam,
dong quai, and valerian root.
- Antidepressants, such as Effexor, Paxil,
and Prozac have been proved moderately effective in clinical trials; however, they have not been approved for this use.
Vaginal dryness
- Vaginal lubricants and moisturizers (available over
the counter).
- Products that release estrogen locally (such as
vaginal creams, a vaginal suppository, called Vagifem, and a plastic ring,
called an Estring)these are used for more severe dryness. The ring
contains a low dose of estrogen and may not protect against osteoporosis. It
also must be changed every 3 months.
Mood swings
- Lifestyle behaviors, including getting enough
sleep and being physically active
- Relaxation exercises
- Antidepressant or anti-anxiety drugs
Insomnia
- Over-the-counter sleep aids
- Milk products, such as a glass of milk or cup of
yogurtchoose low- or fat-free varieties
- Do physical activity in the morning or early
afternoon exercising later in the day may increase wakefulness
- Hot shower or bath immediately before going to bed
Memory problems
- Mental exercises
- Lifestyle behaviors, especially getting enough
sleep and being physically active
|
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Postmenopausal Use
Menopause may cause other changes that produce no symptoms
yet affect your health. For instance, a woman's risk of developing heart
disease begins to rise around menopause. After menopause, women's rate of bone
loss increases. The increased rate can lead to osteoporosis, which may in turn
increase the risk of bone fractures, usually after age 70.
Through the years, studies were finding evidence that
estrogen might help with some of these postmenopausal health risks
especially heart disease and osteoporosis. With more than 40 million American
women over age 50, the promise seemed great.
Although erroneously thought of in the past as a "man's
disease," heart disease is the leading killer of American women. Women
typically develop it about 10 years later than men.
Similarly, menopause is a time of increased bone loss. Bone
is living tissue. Old bone is continuously being broken down and new bone
formed in its place. With menopause, bone loss is greater and, if not enough
new bone is made, the result can be weakened bones and osteoporosis, which
increases the risk of breaks. One of every two women over age 50 will have an
osteoporosis-related fracture during her life.
Many scientists believed these increased health risks were
linked to the postmenopausal drop in estrogen produced by the ovaries and that
replacing estrogen would help protect against the diseases.
Box 5 |
About Dietary Supplements
If you use
dietary supplements to try to ease hot flashes and other menopausal symptoms,
you should bear these points in mind: The U.S. Food and Drug Administration
(FDA) does not have the authority to approve dietary supplements before they
are marketed, and it's important to tell your health care provider that you are
taking such remedies.
Dietary supplements are sold over the
counter and may contain phytoestrogens: These are estrogen-like substances that
come from some plants (such as soy) and plant materials (such as legumes,
vegetables, cereals, and some herbs). For instance, these products may contain
black cohosh, wild yams, dong quai, and valerian root.
Dietary supplement manufacturers are
responsible for making sure that their products are safe. The FDA must show
that a dietary supplement is harmful before it can limit the product's use or
remove it from the market. Currently, there are no FDA regulations that
specifically establish minimum standards for the manufacture of dietary
supplements in order to insure their identity (tests to insure that the
ingredient is actually what its label claims), purity, quality, strength, and
composition. You may want to contact a product's manufacturer before buying it.
Furthermore, the possible effects of
the products are not known. Some of the substances they contain are being
studied. For example, soy contains plant estrogens, which are being studied to
see if they have the same risks and benefits as estrogen.
Some of this research is being
supported by the Office of Dietary Supplements, the National Center for
Complementary and Alternative Medicine, the National Institute on Aging, and
other units of the National Institutes of Health.
Until more is known about these
substances, you should use them with caution. Also, as noted, tell your health
care provider if you take a dietary supplement or if you increase your intake
of dietary phytoestrogens. There may be dangerous side effects. An increase in
the level of estrogens in your body could interfere with other prescription
medications you are taking or even cause an overdose. |
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Early Findings
Early studies seemed to support hormone therapy's ability to
protect women against the diseases that tend to occur after menopause. For
instance, research showed that the treatment does prevent osteoporosis.
However, other findings lacked evidence or were unclear. No large clinical
trials had proved that hormone therapy prevents heart disease or fractures.
Answers also were needed about other possible effects of long-term use of
hormones, especially on such conditions as breast and colorectal cancers.
Further, prior research on postmenopausal hormone therapy's
effect on heart disease had involved mainly observational studies, which can
indicate possible relationships between behaviors or treatments and disease,
but cannot establish a cause-and-effect tie. (See Box 6 for
more about types of studies.)
Box 6 |
What We Lean From Different Types of
Studies
Medical researchers conduct many types
of studies. The reason is that the studies yield different kinds of
information. Together, the studies help scientists understand health and
disease, and how to educate people so they can lead healthier lives.
Three main types are: observational
studies, clinical trials, and community prevention studies. Each type is
discussed briefly below:
Observational studies follow women's medical and lifestyle practices but do
not intervene. Such studies can turn up possible relationships between various
factors and health or illness. Those factors include population traits,
ethnicity, genetic attributes, and behaviors. For instance, researchers can
track women who do and do not take postmenopausal hormone therapy. The results
may show that the hormone users have fewer heart attacks. But the results
cannot conclude that hormone therapy reduces the risk of heart disease. Other
factors may have played a part. For instance, compared with women who do not
use hormone therapy, those who do are often healthier, have a higher level of
education and better access to medical care, and are more willing to follow a
prescribed therapy.
Clinical trials control and
compare specific medical interventions, such as the use of postmenopausal
hormone therapy. Women on an intervention are compared with those who do not
receive the treatment. Researchers try to control all of the experimental
conditions so that any difference between the two groups can be tied to the
intervention.
The most rigorous of these
investigations is the randomized, controlled, double-blinded clinical trial.
Women are randomly assigned to the study groups and, in a drug trial for
instance, neither the women nor the researchers typically know who is receiving
an active drug and who a placebo. Further, on average women in the two groups
will be similar in age, education, health at the time of entering the trial,
and other factors that may affect the results. These trials are considered to
be the "gold standard" among types of studies because they yield the most
reliable information. Clinical trials are often done to test whether a possible
relationship uncovered in an observational study is in fact so. The trials help
establish a causal link between a treatment and a specific medical outcome,
such as fewer heart attacks.
Community prevention studies
explore ways to encourage people to adopt healthier behaviors. |
There also were some clinical trials, which are considered
the "gold standard" in establishing a cause-and-effect connection between a
behavior or treatment and a disease. The most definitive clinical trials are
those that test the effects of a treatment on the disease itself. But such
clinical trials are time-consuming and costly. Consequently, early clinical
trials of postmenopausal hormone use tested the therapy's effects on the risk
factors or predictors of various diseases. One of the most important of these
early clinical trials that tested effects on risk factors was the
"Postmenopausal Estrogen/ Progestin Interventions Trial," or PEPI. Supported by
the National Heart, Lung, and Blood Institute (NHLBI) and other units of the
National Institutes of Health (NIH), PEPI tested the effects of four hormone
regimens (one estrogenonly and three different estrogen plus progestin
regimens) on key risk factors for heart disease and bone mass. Begun in 1987,
it followed 875 healthy, postmenopausal women, ages 45-64, for 3 years. About a
third of the women had had a hysterectomy. Participants included various races
but were predominantly white.
Box 7 |
Risk Factors for Uterine Cancer
There are various types of uterine
cancer. The most common is endometrial cancer, which begins in the lining
(endometrium) of the uterus. It is often referred to as uterine cancer.
Key risk factors for uterine cancer
are:
- Ageusually occurs after age 50
- Endometrial hyperplasiaan increase in cells
in the lining of the uterus
- Hormone therapyusing estrogen without
progesterone
- Obesity and related conditions
- Tamoxifentaken to prevent breast cancer
- Racewhite women are more likely than African
American women to develop uterine cancer
- Colorectal cancerthose who have an inherited
form are at a higher risk of developing uterine cancer
- Factors that increase exposure to
estrogennot having children, starting menstruation at an early age,
entering menopause late
|
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PEPI's results were generally positive:
- Each of the hormone regimens reduced "bad" LDL
cholesterol and raised "good" HDL cholesterol, although estrogen-only raised
good cholesterol the most. (LDL, or low density lipoprotein, carries
cholesterol to tissues, including the arteries, while HDL, or high density
lipoprotein, carries it away, aiding its removal from the body.)
- All hormone therapies decreased levels of fibrinogen.
(High levels of fibrinogen allow blood clots to form more readily, thus
increasing the risk of heart disease and stroke.)
- On the other hand, a large percentage of those who took
estrogen alone had a high rate of overgrowth of the uterine lining and other
abnormalities. This finding stressed the need for women with a uterus to use
estrogen plus progestin therapy. The added progestin protects women against
uterine cancer (see Box 7).
Box 8 |
Breast Cancer Risk Factors
About 80 percent of breast cancer
cases occur after age 50. One of every eight American women who live to be 85
develops breast cancer. Some factors increase the risk for breast cancer.
However, most women who develop breast cancer do not have any of the risk
factors.
Key factors that increase the risk
of developing breast cancer are:
- Personal historyif you've had it once,
you're more likely to develop it again
- Family historyif your mother, sister, or
daughter had breast cancer, especially at an early age, you're more likely to
develop it
- Other breast changes (not including ordinary
"lumpiness")such as atypical hyperplasia (an irregular pattern of cell
growth)
- Genetic alterationschanges in certain genes,
including BRCA1 and BRCA2 mutations
Other factors also may increase the
risk of developing breast cancer. These include:
- Racewhite women are more likely to develop it
than African American or Asian women
- Estrogen exposurerisk is somewhat increased
for those who began menstruation early (before age 12), had menopause late
(after age 55), never had children, or took hormone therapy for long periods
- Late childbearinghaving a first child after
about age 30
- Radiation therapyif given to the chest more
than 10 years ago, especially in women younger than age 30
- Breast densitybreasts with a high proportion
of lobular and ductal tissue, which is dense and in which breast cancers
usually appear
- Alcoholic beverage consumption
|
PEPI did not last long enough to tackle some crucial
questions about hormone therapy, such as a possible rise in breast cancer risk
(see Box 8).
The first clinical trial to investigate the effects of
postmenopausal hormone therapy directly on diseases was the "Heart and
Estrogen-Progestin Replacement Study," or HERS, which began enrolling
participants in January 1983. HERS tested whether estrogen plus progestin would
prevent a second heart attack or other coronary event. Altogether, it involved
2,763 postmenopausal women, average age 67, who already had heart disease. The
women received either estrogen plus progestin or a placebo for about 4 years.
(A placebo is a substance that looks like the real drug but has no biologic
effect.)
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Box 9 |
WHI Findings On Estrogen Plus Progestin
Therapy
Compared with a placebo, after about 5
years of use, estrogen plus progestin resulted in:
Increased risks
- 26% increase in breast cancer
- 41% increase in strokes
- 29% increase in heart attacks
- Doubled rates of blood clots in legs and lungs
Increased benefits
- 37% less colorectal cancer
- 34% fewer hip fractures
No difference
|
Box 10 [skip to text version] |
Estrogen Plus Progestin Pills vs. Placebo
Pills
The rate of the following medical
conditions per 10,000 women per year
|
Box 10 Text
Version [skip to graphical version] |
Estrogen Plus Progestin Pills vs. Placebo
Pills
The rate of the following medical
conditions per 10,000 women per year
|
Placebo Pills
|
Estrogen Plus Progestin
Pills |
Breast Cancer |
30 |
38 |
Heart Attack |
30 |
37 |
Stroke |
21 |
29 |
Total Blood Clots |
16 |
34 |
Hip Fracture |
15 |
10 |
Colorectal Cancer |
16 |
10 |
|
Findings, released in 1998, showed that those on the hormone
therapy did not have fewer fatal or nonfatal heart attacks. In fact, the
women's risk for a heart attack increased during the first year of hormone use,
declining thereafter. HERS also showed that the therapy caused an increase in
blood clots in the legs and lungs.
More recently, the "HERS Follow-Up Study," which tracked the
women for about 3 more years, found no decrease in heart disease from use of
estrogen plus progestin therapy.
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Box 11 |
What Do the Data Really Mean?
The data sound scaryand
confusing. A 41 percent increase in strokes. A 34 percent decline in hip
fractures. Which is more important? The bad news, or the good?
Either
way, the percentages sound big. So it's good to take a moment and check out
what they're really saying.
There are two main ways to express
risk"relative risk" and "absolute risk." The relative risk measures and
compares the percent change in risk of some health-related event in a
population that has been exposed to some agent and another that has not. The
increase (or decrease) in absolute risk is an estimate of the number or
proportion of women who will (or will not) develop a disease when exposed to a
particular agent.
Relative risk allows scientists to
compare data. In the WHI study, for example, scientists wanted to find out the
relative risk of breast cancer in women who had and had not been exposed to the
estrogen plus progestin hormone therapy. After about 5 years, the study had 166
cases of breast cancer among estrogen plus progestin users, compared with 124
in the placebo group. However, there were more woman in the hormone
group8,506, compared with 8,102 in the placebo group. To be able to
compare data from the groups, the cases were converted into rates per 10,000
women per year. Thus, the rate of breast cancer in the hormone group was 38 per
10,000 women, compared with 30 per 10,000 women in the placebo group. This also
can be expressed as 38 divided by 30 or 1.26. Since that is 0.26 greater than
an equal risk (or 1.00), the women on hormone therapy had a 26 percent greater
chance of developing breast cancer than non-users.
What was the increase in absolute risk
of developing breast cancer for women in the WHI study? On average, in any
single year, 0.08 percent more women in the hormone group developed breast
cancer than women in the placebo group. This means that, if a group of 10,000
women takes estrogen plus progestin for a year, there will be 8 more cases of
breast cancer among the hormone users than if they hadn't taken the therapy.
Thus, women on the hormone therapy have only a slightly increased absolute risk
of breast cancer over a year. (See Boxes 9 and
10 for a summary of the relative and absolute risks of
breast cancer and other conditions for women in the estrogen plus progestin
study.)
But, if you count up all the added
cases of breast cancer, heart attacks, strokes, and blood clots in the lungs
and subtract the fewer cases of colorectal cancer and hip fractures, you'd
still get about 100 extra harmful events among the 10,000 hormone users after
5.2 yearsthe period the study ran. Multiply that by 10 years and millions
of women and the number of cases of adverse effects grows.
Remember too that reports of increased
risks do not mean you will develop breast cancer or another condition if you
have been using the hormone therapy. Your personal and family medical history,
along with your lifestyle and other influences, play a big role in your chance
of developing a disease. |
The Women's Health Initiative
In 1991, the NHLBI and other units of the NIH launched the
"Women's Health Initiative" (WHI), one of the largest studies of its kind ever
undertaken in the United States. It consists of a set of clinical trials, an
observational study, and a community prevention study, which altogether involve
more than 161,000 healthy, postmenopausal women.
The observational study is looking for predictors and
biological markers for disease and is being conducted at more than 40 centers
across the United States, while the community prevention study, which has
ended, sought to find ways to get women to adopt healthful behaviors and was
done with the Federal Government's Centers for Disease Control and Prevention.
Back to Top
WHI's three clinical trials, conducted at the same U.S.
centers, are designed to test the effects of postmenopausal hormone therapy,
diet modification, and calcium and vitamin D supplements on heart disease,
osteoporotic fractures, and colorectal cancer risk.
Box 12 |
Risk Factors for Stroke
Main risk factors are:
- High blood pressure
- Diabetes
- Cigarette smoking
Other risk factors include:
- Family historystroke appears to run in some
families, whether due to genetics and/or shared lifestyle
- Heavy consumption of alcoholic beverages
- High blood cholesterol
- Menopause
|
The postmenopausal hormone therapy clinical trial has two
parts. The first involved 16,608 postmenopausal women with a uterus who took
either estrogen plus progestin therapy or a placebo. The second involves 10,739
women who have had a hysterectomy and are taking estrogen alone or a placebo.
The estrogen plus progestin trial used 0.625 milligrams of
conjugated equine estrogens taken daily plus 2.5 milligrams of
medroxyprogesterone acetate taken daily (Prempro). Two key reasons that that
combination was chosen are: It is the mostly commonly prescribed form of the
combined hormone therapy in the United States, and, in several observational
studies, it had appeared to benefit women's health.
The women in the WHI estrogen plus progestin study were aged
50 to 79. They enrolled in the study between 1993 and 1998. Their health was
carefully monitored by an independent panel, called the Data and Safety
Monitoring Board (DSMB).
Box 13 |
Risk Factors for Colorectal Cancer
About 30,000 women a year die of
colorectal cancerit is the third-leading cause of cancer deaths for
women, after lung and breast cancers.
Factors that increase the risk of colorectal cancer
include:
- Agerisk increases after age 50
- Dieteating a diet high in fat and calories,
and low in fiber
- Polypsthese are benign growths on the inner
wall of the colon and rectum
- Personal medical historyhaving had cancer of
the ovary, uterus, or breast; also having had colorectal cancer once increases
the chance of developing it again
- Family medical historyhaving first-degree
relatives (parents, siblings, or children) with colorectal cancer, especially
at a young age; risk increases even more if many family members have had
colorectal cancer
- Ulcerative colitisa condition in which the
lining of the colon becomes inflamed
|
The study's main goal was to see if the therapy would help
prevent heart disease and hip fractures. Another goal was to see if those
possible benefits were greater than the possible risks from breast cancer,
endometrial (or uterine) cancer, and blood clots.
The study was to have continued until 2005. However, it was
stopped in July 2002 because the DSMB found an increased risk of breast cancer
and that, overall, risks from use of the hormones outweighed and outnumbered
the benefits. "Outnumbered" means that more women had adverse effects from the
therapy than benefitted from it. The key results are shown in Boxes
9 and 10.
These results show both risks and benefits from use of the
estrogen plus progestin therapy. The key adverse effects were more cases of
breast cancer, heart attacks, strokes, and blood clots. The main benefits were
fewer hip and other fractures and cases of colorectal cancer.
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Box 14 |
Postmenopausal Hormone Therapy and Ovarian Cancer
Risk
Early studies of postmenopausal
hormone therapy found inconsistent results about its effect on the risk of
ovarian cancer: Some reported increased risk with estrogen use, while others
reported no effect or even a protective one. Most of those studies were
relatively small and did not take into account the key risk factors for ovarian
cancer (see Box 15).
More recently, two large observational
studies have indicated that long-term estrogen use increases the risk of
ovarian cancer. It's important to keep in mind that observational studies do
not prove that a treatment causes a disease (see Box 6).
The evidence from these studies is cautionary, not definitive.
Here's more on the studies:
- One study followed 211,581 postmenopausal women
from 1982-1996. Of those, 44,260 had used estrogen-only hormone therapy; the
rest did not use hormone therapy. None of the women had had a hysterectomy,
ovarian surgery, or cancer. Those with 10 or more years of estrogen use had an
increased risk of dying from ovarian cancerand, while the risk decreased
somewhat long after use was stopped, it was still higher than that of women who
had never used estrogen-only therapy.
- Another study followed 44,241 women from
1979-1998. It found that estrogen-only therapy increased the risk of ovarian
cancer. Women who used estrogen alone for 10 or more years had an 80 percent
higher risk of ovarian cancer than women who had never used the hormone
therapy; women who used estrogen alone for 20 or more years had a 220 percent
higher risk than women who had never used hormone therapy.
The study
found no increased risk of ovarian cancer for users of estrogen plus progestin.
However, few women in the study had used the combination therapy for more than
4 years.
More research is needed to see if
estrogen plus progestin affects ovarian cancer riskand on other aspects
of postmenopausal hormone use. For instance, another recent study found that
estrogen alone or estrogen plus progestin used on a sequential basis increased
the risk for ovarian cancer, while estrogen plus progestin used continuously
did not. |
Additionally, there was no increase in deaths from breast
cancer or from other causes. Further, there was no increase in the risk of
endometrial cancer. Here's more on the findingsto better understand them,
see "Putting It All Together," as well as Box 11:
- Breast cancer. The increased risk of breast
cancer appeared after 4 years of hormone use. After 5.2 years, estrogen plus
progestin resulted in a 26 percent increase in the risk of breast
canceror 8 more breast cancers each year for every 10,000 women. Women
who had used estrogen plus progestin before entering the study were more likely
to develop breast cancer than others, indicating that the therapy may have a
cumulative effect.
- Heart attack. For heart attack, the risk began to
increase in the first year of estrogen plus progestin use and became more
pronounced in the second year. After 5.2 years, there were 29 percent more
heart attacks in the estrogen plus progestin group than in the placebo
groupor 7 more heart attacks each year for every 10,000 women. Unlike
HERS, which involved women with heart disease, the increased risk from estrogen
plus progestin did not go back down again.
- Stroke. For the first time, estrogen plus
progestin was shown to cause more strokes in healthy women. By the end of the
study, the estrogen plus progestin group had 41 percent more strokes than the
placebo groupor 8 more strokes each year for every 10,000 women.
- Blood clots. The risk of total blood clots was
greatest during the first 2 years of hormone usefour times higher than
that of placebo users. By the end of the study, it had decreased to two times
greateror 18 more women with blood clots each year for every 10,000
women.
- Fractures. Estrogen plus progestin reduced hip
fractures by 34 percentor 5 fewer hip fractures for every 10,000 women.
This is the first solid evidence from a clinical trial that hormone therapy, in
helping to prevent bone loss and osteoporosis, protects women against
fractures.
- Colorectal cancer. The therapy also lowered the
risk of colorectal cancer by 37 percentor 6 fewer colorectal cancers each
year for every 10,000 women. This reduction appeared after 3 years of hormone
use and became more significant thereafter. However, the number of cases of
colorectal cancer was relatively small, and more research is needed to confirm
the finding.
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Box 15 |
Risk Factors for Ovarian Cancer
About 1 in 57 American women will
develop ovarian cancer. Most will be over age 50, but younger women also can
develop the disease.
Here are some factors that increase or
decrease the risk of ovarian cancer:
Increases risk
- Agerisk increases as a woman ages
- Family history of ovarian cancerhigher risk
if mother or sister has had ovarian cancer; somewhat higher risk if other
relatives, such as grandmother, aunt, or cousin, have developed ovarian cancer
- Postmenopausal hormone therapymay increase
risk
- Fertility drugs
- Personal history of breast and/or colon cancer
Decreases risk
- Oral contraceptivesthe longer the use, the
lower the risk may be and the decrease may last after use has ended
- Childbearing and breast-feeding
- Tubal ligation (sterilization) or hysterectomy
- Prophylactic (to prevent or protect) oophorectomy
(surgery to remove one or both ovaries)
|
The findings are important for several reasons: As a
clinical trial, they establish a causal link between use of the particular
hormone therapy and its effects on diseases. Further, the findings finally
offer some firm guidance to the millions of American women who have a uterus
and may consider taking the drugs6 million already use a form of
combination therapy. And, the results apply broadlythe study found no
differences in risk by prior health status, age, or ethnicity. The findings do
not apply to postmenopausal use of estrogen alone. That arm of the study, which
used 0.625 mg per day of conjugated equine estrogen (Premarin), did not have
the same increased breast cancer risk and continues.
However, an observational study, supported by the NIH's
National Cancer Institute (NCI), recently found that estrogen-only therapy
appeared to increase the risk of ovarian cancer (see Box
14). But other, similar studies have not found such an increased risk, and
the possible relationship between estrogen use and ovarian cancer remains
unclear. WHI participants were informed of these findings, and the results were
reviewed for their significance to the study's continuation.
Box 16 |
What About Birth Control Pills?
The recent findings about the risks of
long-term postmenopausal hormone therapy do not apply to use of birth control
pills, which have not been found to increase breast cancer risk.
There had been concern about the effect of birth control pills on
the risk of breast cancer because, until recently, studies had given
conflicting results. For example, a 1996 analysis of 54 small studies had found
a slight increase among women who were or had recently used oral
contraceptives. But the 54 studies differed in quality and some included oral
contraceptive preparations no longer in use. Other studies, such as the 1986
"Cancer and Steroid Hormone" (CASH) study, had found no increased risk.
In June 2002, findings of the "Women's
Contraceptive and Reproductive Experiences Study" (also called the Women's CARE
Study) were released and showed no increased risk of breast cancer, regardless
of length of oral contraceptive use, timing of use, age at use, or the users'
risk factors for developing breast cancer. The study, supported by the NIH's
National Institute of Child Health and Human Development, involved more than
9,257 women between the ages of 35 and 64. The women were interviewed about
their contraceptive use.
Oral contraceptives do pose risks,
however: Combination oral contraceptives increase the risk of blood clots. Oral
contraceptives should not be used if you are at an elevated risk for blood
clots because of diabetes or another condition, or if you smoke. Taking oral
contraceptives and smoking increases your risk for heart attack and stroke.
Oral contraceptive use has benefits
too: It can reduce the risk of ovarian cancer, endometrial cancer, colorectal
cancer, pelvic inflammatory disease (an infection that can lead to
infertility), and osteoporosis. |
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Putting It All Together
How can you sort through the benefits and risks and make a
good decision about whether or not to use postmenopausal hormone therapy? Here
are several points to help you evaluate the findings:
First, it's important to know that, because the study
involved healthy women, only a small number of them had either a negative or
positive effect from estrogen plus progestin therapy.
The percentages describe what would happen to a whole
populationnot to an individual woman. For example, the increased risk of
breast cancer for the women in the WHI study who were taking the estrogen plus
progestin therapy was less than a tenth of 1 percent each year.
But if you apply that increased risk to a large group of
women and over several years, then the number of women affected becomes an
important public health concern. As noted, about 6 million American women take
estrogen plus progestin therapy. That would translate into nearly 6,000 more
cases of breast cancer every year and, if all of the women took the
therapy for 5 years, that might result in 30,000 more cases of breast cancer.
Box 17 |
Talking With Your Doctor
It's important to be involved in your
health care. Ask questions and express your concerns. Here are some questions
that may help you talk with your health care provider about hormone therapy:
- Why am I taking hormone therapy? Or why should I
take hormone therapy?
- Which hormone therapy am I on?
- What are my risks for heart disease, breast
cancer, and osteoporosis?
- Should I stop taking the hormone therapy?
- What's the best way for me to stop? What side
effects will I have?
- Is there an alternative therapy that I can use
long-term?
- What alternatives can help me prevent heart
disease?
- What alternatives can help me prevent
osteoporosis?
- What can I do to keep menopausal symptoms from
returning?
Your risk for heart disease,
osteoporosis, and colorectal cancer may change over time. So remember to
regularly review your health status with your doctor or other health care
provider.
It's also important to bear in mind that your doctor
or other health care provider may not be able to answer all of your
questionsmany questions about postmenopausal hormone use remain. For
instance, it's not yet known if increases in disease risk caused by long-term
use of estrogen plus progestin drop after use stops. As with any treatment, you
need to carefully weigh your personal risks against the possible benefits and
make the best choice possible for your health and lifestyle needs.
Finally, your doctor or other health
care provider can speak with a WHI Principal Investigator about the study's
results. For a list of the Principal Investigators, check the NHLBI WHI Web
site or contact the NHLBI Health Information Center. |
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Second, bear in mind that percentages aren't fate. Whether
expressing risks or benefits, they do not mean you will develop a disease. Many
factors affect that likelihood, including your lifestyle and other
environmental factors, heredity, and your personal medical history.
Finally, realize that most treatments carry risks and
benefits. No one can make a treatment choice for you. Talk with your doctor or
other health care provider and decide what's best for your health and quality
of life. Begin by finding out your personal risk profile for heart disease,
stroke, breast cancer, osteoporosis, colorectal cancer, and other conditions
(see Boxes 7, 8, 12, 13, 15,
18, and 20). Discuss quality of life
issues and alternatives to postmenopausal hormone therapy. Box
17 will help you talk with your health care provider. Then weigh every
factor carefully and choose the best option for your health and quality of
life. And keep the dialogue goingyour health status can change and so can
your choice.
Box 18 |
Your Heart Disease Risk Profile
One in three American women dies of
heart disease. Heart disease kills more American women than any other cause. It
also can lead to disability and decrease one's quality of life. Yet, many women
don't take the threat of heart disease seriously.
But menopause is a time when you need to get very
serious about heart disease because that's when your risk for it starts to
rise. So, it's more important than ever to talk with your health care provider
about how to lower your risk of heart diseaseor, if you already have it,
to keep it under control. Ask about your "heart disease profile," a check of
the heart disease risk factors you already have or are at an increased risk of
developing.
Risk factors are behaviors or
conditions that increase your chance of developing a disease. The more risk
factors you have, the greater your chance of developing the disease. For heart
disease, the risk factors don't just add their risksthey multiply them.
So it's vital to prevent them or, if you already have any, to keep them under
control.
Fortunately, most heart disease risk
factors can be prevented or controlled. Here's a breakdown of both types:
Risk factors beyond your control
- Being age 55 or older
- Having a family history of early heart
diseasethis means having a mother or sister who has been diagnosed with
heart disease before age 65, or a father or brother diagnosed before age 55
Risk factors you can
control
- Cigarette smoking
- High blood cholesterol
- High blood pressure
- Diabetes (high blood sugar)
- Overweight/obesity
- Physical inactivity
For more on how to start reducing your
heart disease risk, see the resources list. |
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Advice About Postmenopausal Hormone
Therapy
While many questions remain, the new WHI findings provide
the basis for some advice about the use of postmenopausal hormone therapy. Here
it is, along with advice for short-term hormone use to relieve menopausal
symptoms:
Short-term estrogen alone or estrogen plus progestin
therapy
- "Short-term" means the shortest time needed to manage
menopausal symptoms. The benefits of such use could outweigh any risks for you.
Most women use the hormone therapy for 2 to 3 years. However, some may require
a longer period of treatment. Talk with your health care provider about your
personal risks and needs.
Long-term estrogen plus progestin therapy
- Do not use estrogen plus progestin therapy to prevent
heart disease. The new findings show that it doesn't work. In fact, the therapy
increases the chance of a heart attack or stroke. And it increases the risk of
breast cancer and blood clots.
What can you do instead? Talk to your
health care provider about other ways to prevent heart disease and stroke that
have been proven to be safe and effective. These include lifestyle changes and
such drugs as cholesterol-lowering statins and blood pressure medications.
Lifestyle changes include: not smoking, maintaining a healthy weight, being
physically active, and managing diabetes.
Another key part of this is
to follow a healthy eating plan that has a variety of foods and is low in
saturated fat and cholesterol and moderate in total fat. In addition, limiting
how much salt and other forms of sodium you eat will help keep your blood
pressure at a healthy level.
- Do not use long-term postmenopausal hormone therapy if
you already have heart disease. Such use increases the risk of blood clots. It
also increases the risk of heart attack in the first year of therapy.
- To prevent osteoporosis, talk with your health care
provider about what your personal risks and benefits would be from estrogen
plus progestin therapy. Weigh any benefits against your risk of heart disease,
stroke, and breast cancer. Ask about alternate approaches that are considered
safe and effective in preventing osteoporosis and fractures. These include oral
biphosphonates, such as alendronate (or Fosamax) and risedronate (or Actonel),
and selective estrogen receptor modulators (SERMs), such as raloxifene (or
Evista). SERMs are also known as designer estrogens. They are substances that
have estrogen-like effects on some tissues and anti-estrogen effects on others.
Other steps to prevent osteoporosis include consuming enough calcium
and vitamin D (see Box 19), being physically active,
especially with weight-bearing exercises (such as walking, jogging, playing
tennis, and dancing), not smoking, and limiting how many alcoholic beverages
you drink. Smoking and drinking alcohol increase your risk of osteoporosis. For
more on osteoporosis, see Box 20.
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Box 19 |
Recommended Daily Intakes of Calcium and Vitamin
D
|
Age |
Vitamin D |
Calcium |
19-50 |
200 IU* |
1,200 mg** |
51-70 |
400 IU* |
1,200 mg** |
70+ |
600 IU* |
1,200 mg** |
Note: IU=International
Units
* not to exceed 2,000 IU ** not to
exceed 2,500 mg |
Long-term estrogen-only therapy
- The WHI has not yet issued findings about the health
risks and benefits of long-term use of estrogen-only therapy. Consult your
health care provider about your personal health profile and needs.
General advice
- Whether or not you decide to use postmenopausal hormone
therapy, you should keep your regular schedule of mammograms, and breast and
clinical exams.
- In addition to having regular mammograms, you should
protect your health by having certain other tests done too (see Box 21). These include tests for high blood pressure,
high blood cholesterol, high blood glucose (sugar), bone mineral density, and
overweight.
- If you stop taking hormone therapy and your menopausal
symptoms return, consider alternative treatments (see Box
4). Be aware that some of these remedies have not been proved effective or
safe.
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Box 20 |
Boning Up On Osteoporosis
More than 8 million American women
have osteoporosisand millions more have lost so much bone that they're
likely to develop it.
Osteoporosis can happen at any age but
the risk grows as you get older. The first noticeable sign of osteoporosis is
often losing height or having a bone break easily. Other signs can be changes
in the shape of the spine, prolonged severe pain in the middle of the back, and
tooth loss.
Risk factors of osteoporosis
include:
- Agerisk increases as you grow older
- Being a womanwomen have less bone tissue and
lose bone faster than men
- Body sizesmall, thin-boned women are at
greatest risk
- Ethnicitywhite and Asian women are at
highest risk
- Family historyhaving parents with a history
of fractures
- Sex hormonesabnormal absence of menstrual
periods (amenorrhea) or menopause
- Anorexia
- Lifetime diet low in calcium and vitamin D
- Certain medications, such as glucocorticoids
(prescribed for various diseases, including arthritis, asthma, and lupus) or
some anticonvulsants
- Physical inactivity or extended bed rest
- Cigarette smoking
- Excessive use of alcoholic beverages
If you think
you're at risk for osteoporosis or if you're menopausal or older, you may want
to ask your doctor or other health care provider about having a test called a
DXA-scan (dual-energy x-ray absorptiometry). It measures spine, hip, or total
body bone mineral density, or how solid bones are. The results can show the
presence and severity of osteoporosis, or if you're at risk of developing it or
having fractures.
You can prevent osteoporosis. The key
steps are to follow an eating plan that's rich in calcium and vitamin D and be
sure to get regular weight-bearing exercises. Calcium and vitamin D intake can
be taken as supplements but check with your health care provider first. Too
much of either can cause problems. Recommended daily intakes of calcium and
vitamin D are given in Box 19. Good food sources of
calcium include lowfat dairy foods, canned fish with bones, such as salmon and
sardines, dark-green leafy vegetables, such as broccoli, kale, and collards,
calcium-fortified orange juice, and breads made with calcium-fortified flour.
Vitamin D is made by the bodybeing in the sun 20 minutes a day helps most
women make enough. But it's also found in eggs, fatty fish (such as sardines,
mackerel, and salmon), and cereal and milk fortified with vitamin D.
Weight-bearing exercisesdone three to four times a weekthat help
prevent osteoporosis include walking, jogging, stairclimbing, weight training,
tennis, and dancing.
It's also important not to smoke and
to limit how many alcoholic beverages you drink. Smoking causes the body to
make less estrogen, which protects bones. Too much alcohol can put you at risk
for falling and breaking bones.
Osteoporosis is treated by stopping
bone loss with lifestyle changes and medication. Hormone therapy has been used
to prevent and treat osteoporosis. But other drugs are available:
- Raloxifene is a SERM. It may cause hot flashes and
blood clots.
- Alendronate (brand name Fosamax) and risedronate
(brand name Actonel) are bisphosphonates, drugs that slow the breakdown of bone
and may increase bone density. Side effects may include nausea, heartburn, and
pain in the stomach.
- Calcitonin is a naturally occurring non-sex
hormone that increases bone mass in the spine. It is used for women who are at
least 5 years beyond menopause and is taken by injection or nasal spray. The
injection may cause an allergic reaction and has some unpleasant side effects,
including flushing of the face and hands, urinating often, nausea, and skin
rash. The nasal spray may cause a runny nose.
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How Do I Stop Postmenopausal Hormone
Therapy?
You should talk with your health care provider about whether
or not stopping postmenopausal hormone therapy would be good for you. Also ask
about the best way to discontinue the treatment. You can stop abruptly or by
gradually reducing the dose over several months.
However, by abruptly stopping the medication, you may have
menopause-like symptoms. Gradually weaning your body off the medication can
ease this.
Box 21 |
Check It Out
Here's a prescription for better health:
- Blood pressurehealthy women should have it
checked every 2 years; others may need it checked more often.
- Lipoprotein profilechecks blood levels of
LDL, HDL, total cholesterol, and triglycerides; healthy women should have it
once every 5 years.
- Blood glucosetests blood levels of glucose
(a sugar) and indicates risk for diabetes; healthy women age 45 and older
should have it, especially if they are overweight; if it's normal and women are
healthy and not overweight, it should be taken again in 3 years, while others
will need it more often.
- Overweight and obesity checkthis is done by
calculating your body mass index (BMI) and measuring your waist circumference.
BMI is a measure of your weight relative to your height, while waist
circumference measures abdominal fat. Box 22 tells you how
to calculate BMI. A BMI of 25 or higher is overweight or obese. For women, a
waist circumference of more than 35 inches indicates an increased risk for
heart disease and other conditions. Your health care provider also will check
you for other risk factors and conditions associated with obesity to determine
the best treatment.
- Mammograma special x ray of the breast;
healthy women age 40 and older should be screened for breast cancer with
mammography once every 1 to 2 years; studies show screening is especially
important for those aged 50-69; women also should do breast self-exams and have
their doctor or health care provider do a clinical breast exam during routine
physical exams.
- Pap Smearthis test checks a sample of
cervical cells for changes that may lead to cancer; begin by having it as part
of an annual gynecological exam and, if normal 3 years in a row, talk with your
doctor about how often to have it after that.
- Colonoscopyexamines the inside of the colon
and rectum using a thin, lighted tube called a colonoscope; healthy women
should have it once every 5 years starting at age 50.
- Bone densitythis x-ray measures bone
thickness and strength; postmenopausal women with one or more risk factors for
osteoporosis (besides menopause) or who suffer fractures, and women age 65 and
older regardless of added risk factors should have this test.
- Electrocardiogram (EKG or ECG)this tests the
heart's electrical activity as it beats; women over age 40 should have a
baseline EKG.
|
Questions Remain
The new findings have provided some details about the
dangers and benefits of postmenopausal hormone therapy, but many questions
remain. The WHI is following women in the estrogen plus progestin trial to see
if and when increased risks and benefits decline after use of the therapy ends.
Also, in 2005, the WHI is expected to release key information about the effects
of postmenopausal estrogen-only therapy.
Other WHI studies include:
- The observational study is examining other forms of
hormone therapy, including other estrogens, progestins, and SERMs.
- The postmenopausal hormone therapy trial has been
investigating hormones' effects on memory. While the estrogen plus progestin
part of that study ended, the estrogen-only arm continues.
- A WHI substudy is examining hormones' ability to prevent
or delay Alzheimer's disease and other forms of dementia.
Additionally, scientists funded by the NHLBI, the National
Cancer Institute, the National Institute on Aging, the National Institute of
Arthritis and Musculoskeletal and Skin Diseases, the National Center for
Complementary and Alternative Medicine, the National Institute of Mental
Health, and other units of the NIH are supporting research on the effects of
postmenopausal hormones and alternative therapies on the symptoms of menopause
and conditions that occur after menopause. The research includes studies of:
the effects of soy phytoestrogens on cardiovascular disease and osteoporosis,
postmenopausal use of phytoestrogens on cardiovascular risk and health, black
cohosh and antidepressants on hot flashes, botanical dietary supplements on
women's health, plant estrogens on breast cancer, and estrogen on cognition.
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Box 22 |
Check Your BMI
Body mass indexor
BMIrelates weight to height and is used as an indicator of total body
fat. It is used with waist circumference to see if you're overweight or obese.
To find your BMI, use the method below
or go to the Aim For A Healthy Weight Web page at
www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/index.htm,
which offers tables and an automatic calculator.
Here are three steps to find your
BMI: |
Step 1 |
Multiply your weight* in pounds by
703. |
Step 2 |
Divide the answer by your height in
inches. |
Step 3 |
Divide the answer again by your
height in inches. |
The BMI score means:
|
18.5-24.9 |
Normal |
25.0-29.9 |
Overweight |
30.0 and above |
Obese |
*Weight wearing underwear but no
shoes
|
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For More Information
The following resources can help you lean more about hormone
therapy-related topics:
National Heart, Lung, and Blood Institute
National Institutes of Health NHLBI Health Information Center
P.O. Box 30105 Bethesda, MD 20824-30105 Phone: (301) 592-8573
TTY: (204) 629-3255 Fax: (301) 592-8563 Web site:
www.nhlbi.nih.gov WHI Web site:
www.whi.org
National Cancer Institute National Institutes
of Health Phone: (800) 4-CANCER (800-422-6237)
Web site: www.nci.nih.gov
National Center for Alternative and Complementary
Medicine National Institutes of Health NCCAM Clearinghouse P.O.
Box 7923 Gaithersburg, MD 20898-7923 Phone: (888) 644-6226 TTY:
(866) 464-3615 International Phone: (301) 519-3153 Fax: (866) 464-3616
Web site: www.nccam.nih.gov
National Institute on Aging National Institutes
of Health Phone: (800) 222-2225 TTY: (800) 222-4225 Web site:
www.nia.nih.gov
National Institute of Arthritis and Musculoskeletal
and Skin Diseases National Institutes of Health NIAMS Information
Clearinghouse 1 AMS Circle Bethesda, MD 20892-3675 Phone: (301)
495-4484 or (877) 226-4267 TTY: (301) 565-2966
Fax: (301) 718-6366 Web site: www.niams.nih.gov
NIH Osteoporosis and Related Bone Diseases~National
Resource Center 1232 22nd Street, NW Washington, DC 20037-1292
Phone: (202) 223-0344 or (800) 624-BONE Fax:
(202) 293-2356 TTY: (202) 466-4315 Web site:
www.osteo.org
National Institute of Child Health and Human
Development National Institutes of Health NICHD Clearinghouse
P.O. Box 3006 Rockville, MD 20847 Phone: (800) 370-2943
Fax: (301) 984-1473 Email: NICHDClearinghouse@mail.nih.gov Web
site: www.nichd.nih.gov
Food and Drug Administration Department of
Health and Human Services 5600 Fishers Lane Rockville, MD 20857
Phone: (888) INFO-FDA (888-463-6332) Web site:
www.fda.gov |
Office on Women's Health Department of Health
and Human Services 200 Independence Avenue, SW Room 730B
Washington, DC 20201 Phone: (202) 690-7650 Fax: (202) 205-2631
Web site: www.4women.gov/owh
National Women's Health Information Center
Department of Health and Human Services 8550 Arlington Boulevard
Suite 300 Fairfax, VA 22031 Phone: (800) 994-WOMAN
(800-994-9662) or (888) 220-5446
Web site: w target="_new"ww.4women.gov
North American Menopause Society P.O. Box
94527 Cleveland, OH 44101 Phone: (440) 442-7550 Automated Consumer
Request Line: (800) 774-5342 Fax: (440) 442-2660 E-Mail:
info@menopause.org Web site: www.menopause.org
Alliance for Aging Research 2021 K Street,
NW Suite 305 Washington, DC 20006 Phone: (202) 293-2856 Fax:
(202) 785-8574
American Heart Association National Center
7272 Greenville Avenue Dallas, TX 75231 Phone: (800)
AHA-USA-1 (800-242-8721) Web site:
www.americanheart.org
American Stroke Association National Center
7272 Greenville Avenue Dallas, TX 75231 Phone: (888)
4-STROKE (888-478-7653) Web site:
www.strokeassociation.org
National Osteoporosis Foundation 1232 22nd
Street, NW Washington, DC 20037-1292 Phone: (202) 223-2226 Web
site: www.nof.org |
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NIH Publication No. 02-5200 October
2002
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