Safe Way to Ease Menopause? Search Goes On

Another study has tied hormone treatment for severe menopausal symptoms to breast cancer. Millions of women who were taking hormones have stopped. But researchers are still trying to find healthy ways to combat symptoms.

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A new study affirms the strong link between breast cancer and the hormones that many women have taken to tame the symptoms of menopause. Millions of women who are on those hormones have already stopped taking them.

But NPR's Richard Knox reports the questions have not gone away.

RICHARD KNOX: Almost five years ago, one of the largest studies ever on women's health came up with a blockbuster result. Women on hormone replacement therapy have a 26 percent higher risk of breast cancer, 29 percent more heart disease, and a 41 percent higher risk of stroke.

Dr. PETER RAVDIN (Researcher, M.D. Anderson Cancer Center): After those results were published in July of 2002, most women in the United States stopped talking hormone replacement therapy.

KNOX: Dr. Peter Ravdin is a researcher at M.D. Anderson Cancer Center in Texas. Last December, he and his colleagues issued another remarkable finding. The year after, millions of women stopped taking hormone therapy, the U.S. breast cancer rate went down by seven percent.

In this week's New England Journal of Medicine, they're reporting breast cancer incidence for 2004, another nine percent drop.

Dr. RAVDIN: And so that allows us to see that the drop was not a one-year wonder. In fact, it was sustained into a second year.

KNOX: The breast cancer decline has leveled off, another sign it was probably related to the sudden drop in hormone therapy. But there's one big question. When a woman stops hormone therapy, does the tiny undetected tumor in her breast melt away or has its growth just been delayed?

Dr. RAVDIN: We think what's happening is that when she stopped the hormone replacement therapy, any small undetectable breast cancers that she might have actually would grow more slowly. And therefore, their appearance might be delayed. In fact for some women, we're hopeful that small undetectable breast cancers might actually cease growing altogether for very long periods of time.

KNOX: It will take at least five years to answer that question, Ravdin says. Meanwhile, Dr. JoAnn Manson says former hormone users shouldn't let their guard down. Manson is the leader of the Women's Health Initiative, the study that first linked hormone therapy to breast cancer.

Dr. JOANN MANSON (Women's Health Initiative): I don't think that women should assume that simply because they've stopped hormone therapy they're no longer at risk to breast cancer and don't need to be vigilant about mammograms and regular clinical breast exams.

KNOX: But what should menopausal women do if they have severe hot flashes and night sweats that don't go away on their own. This is not a small group. Some research shows a quarter of women, who tried to quit hormone therapy had to go back on the drugs because their symptoms were intolerable.

Dr. Bruce Ettinger has some advice. He's an expert on the subject at the University of California at San Francisco.

Dr. BRUCE ETTINGER (Research Scientist, University of California, San Francisco): We now know that half of the usual amount of estrogen is really a very adequate dose for most women.

KNOX: Ettinger says the standard hormone dose reduces women's hot flashes from an average of 10 a day to two.

Dr. ETTINGER: When they get a half-strength estrogen, they get about a 65 percent reduction in hot flashes. So now they've gone down from 10 hot flashes a day to three or four. Well, that maybe quite enough.

KNOX: In any case, everyone agrees that women who need hormonal relief should take it at the lowest possible dose for the shortest possible time. Ettinger says women should avoid hormone prescriptions that are custom mixed by some pharmacists. As for natural remedies, Ettinger says they're no better or not much better than a sugar pill.

Richard Knox, NPR News.

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