 Oct. 18, 2002 |
| ASSEMBLY EDITION • SAN DIEGO |
This summer, when the Women's Health Initiative study comparing estrogen/progestin with placebo was halted early, the report raised more questions about hormone replacement therapy than it answered -- questions that women are now asking their family physicians to answer.
While pondering these same questions himself, the principal investigator for the San Diego portion of the Women's Health Initiative asks physicians to not overgeneralize the study's results, and also to remember that the negative effects seen in the study were not very large.
"The Women's Health Initiative results are meaningful and probably accurate for the treatment that we stopped, the combination of conjugated equine estrogen and medroxyprogesterone acetate," said Robert Langer, M.D., professor in the department of family and preventive medicine at the University of California, San Diego. "There are good reasons to believe that other combinations would not necessarily bring the same results."
In his Wednesday presentation on "Hormone Replacement Therapy: The State-of-the-Art, 2002," Langer said prescribing for women in his own practice has not changed much, although he is switching many away from medroxyprogesterone acetate-containing regimens because it may be the reason for the adverse effects observed in the WHI and other studies.
"In contrast, there are alternative compounds of that same class shown not to have that adverse effect," Langer said.
He pointed out that there is a likelihood, as with any treatment, that any hormone replacement regimen will have risks and benefits.
"There is no free lunch, and we need to very carefully balance the risks and benefits and have a frank discussion with each patient on at least an annual basis," Langer said. "Then decide if for her, given what we are using and what we know about it, the benefits outweigh the risks."
Langer pointed out that all the questions posed in the Women's Health Initiative were not answered, and that the study was stopped under protocol rules and not because of the answers. He said he believed the study outcomes would have been different depending on the potency of the progesterone formula used. He said he would expect better outcomes with micronized progesterone, because it seems to preserve more of the estrogen benefit.
He also stressed that few women need to be taken off HRT following the study's findings, but he advocated that all women be reassessed for which combination they should be taking.
Langer was asked about the recently released U.S. Preventive Services Task Force recommendation against using combined estrogen and progestin therapy for preventing cardiovascular disease and other chronic conditions in postmenopausal women.
"I think they are jumping the gun there, to say the Women's Health Initiative results apply to all forms of combined therapy," Langer said. "We don't have evidence for that. We only have evidence for the treatment that was tested in the Women's Health Initiative."
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