Ask the Pharmacist

Q: You seem to write about the use of Hormone Replacement Therapy (HRT) in menopausal women every year or two. What are the latest recommendations?

A: The use of hormones (such as estrogen) to treat assorted menopausal symptoms has been as divisive a topic as any other that we can recollect going back to our school days when a professor stated an argument could be made that we should consider adding them to our drinking water (a rather ironic statement 25 years later, given the levels that have been detected in our drinking water and livestock).

About 15 years ago, this line of thinking came to a crashing halt as a massive study showed an association between the oral form (i.e. pill form) of conjugated estrogens taken with progesterone (medroxyprogesterone) and serious medical conditions such as cardiovascular disease, dementia, blood clots and breast cancer. The end result of this study was that the vast majority of females were taken off these drugs and alternative treatments were tried with significantly lower (but far from zero) success rates.

However, as time went on, new studies and a more thorough examination of the previous literature have caused more and more experts to once again suggest HRT to their patients as being both safe and effective. Their recommendations maintain that the benefits of HRT (decreased bone loss, improvement in quality of life, possibly lower risk of heart disease) in those under the age of 60 or within 10 years of their last period, outweigh the aforementioned risks for most females.

Regarding the risk of HRT contributing to breast cancer, this is usually low (one more case of breast cancer per 1,000 women per year when the drugs are taken for four to five years) with most experts agreeing that it is significantly lower than the risk posed by even moderate alcohol consumption.

Estrogen on its own (i.e. without the progesterone part which is an option only for those who do not have an intact uterus) does not seem to increase the risk at all for at least seven years and possibly longer. Extreme caution is warranted in debating whether to use systemic HRT (i.e. pills or patches) in females with a positive family history of breast cancer or who have the BRCA gene mutation (which can be tested for and is linked to a higher risk).

As for breast cancer survivors, the use of vaginal HRT (such as Premarin vaginal cream or Vagifem which treats only the vaginal symptoms such as dryness and incontinence) should only be considered for those with severe symptoms who are not taking the breast cancer prevention pills (known as the aromatase inhibitors) and systemic forms of HRT should never be considered.

When it comes to cardiovascular risks, the debate centres upon what other medical conditions the individual has. For most people with only one cardiovascular risk factor (such as high blood pressure, high cholesterol, diabetes), using low-dose, short-term HRT for severe menopausal symptoms is probably okay.

For those with multiple risk factors or who have previously experienced a stroke, heart attack or blood clot systemic, HRT should be avoided, although the vaginal products are considered safe since so little hormone actually makes it into the bloodstream.

Lastly, as we implied earlier, starting systemic HRT in women over the age of 60 or 10 or more years past menopause, is not a good idea due to the very real concerns regarding higher risks of strokes, dementia and heart attacks. Yes, pharmacists don’t all push drugs all the time; in fact, most of the pharmacists we know tend to take a fairly balanced view when it comes to drug therapy.

Next week, we will discuss the newest HRT therapy which is a unique product, as well as how long experts suggest treatment should continue.

Until then, for more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/?fref=ts