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SOURCES:

Dr. Marcia Stefanick, principal investigator of the Women's Health Initiative and a professor of medicine at Stanford Dr. Jan Herr, menopause clinical guidelines director at Kaiser Permanente of Northern California Serena Levine, a registered nurse and co-chair of a menopause support group in San Francisco Athena Pappas, yoga instructor whose students include menopausal women using the discipline to combat hot flashes and depression Women in a menopause support group

The transcript follows:

NARRATOR:

In July 2002 researchers halted the largest study ever of dual hormone therapy for women. In 1997, at the inception of the study -- known as the Women's Health Initiative, or WHI -- scientists believed that the hormones progestin and estrogen would protect menopausal women against heart disease and major bone fractures. They were right about bone protection. However, mounting evidence showed that menopausal women on those hormones were at greater risk for heart attack, blood clots, stroke, and breast cancer. The revelation has left millions of American women who rely on hormones in a quandary: Should they stop taking them and if so, what are the alternatives? Laurie Udesky reports.

UDESKY: Perhaps the easiest decision to quit hormones is for women who've used them solely to prevent heart disease. The WHI study showed clearly that estrogen and progestin increase that risk. Researchers also say that women should not use the hormones to prevent osteoporosis or brittle bones. That's because the risks outweigh the benefits. But many women rely on hormone replacement therapy, or HRT, to stop symptoms that greatly impinge on their lives. HRT minimizes hot flashes. It cuts recurring insomnia, tempers mood swings, hydrates dry skin, and prevents uncomfortable vaginal dryness. However, Marcia Stefanick, the principal investigator of the WHI and a professor of medicine at Stanford, cautions women that they have to change their thinking about hormones.

DR. STEFANICK: If you have symptoms and need to treat symptoms, the advice is to go as low a dose as you can, as short a time as you can. Just keep asking yourself, why am I taking these hormones because the risks are there right off the bat. And it's just a matter of how long you're going to accumulate those risks.

How the risks are interpreted is equally important. Study participants on progestin and estrogen had a greater risk of breast cancer than women taking placebo, or sugar pill. The risks are real, but they're not the same for every woman, says Dr. Jan Herr. She's the menopause clinical practice guidelines leader for Kaiser Permanente of Northern California:

DR. HERR: Women that have a strong family history of breast cancer and having a mom -- especially if she had breast cancer premenopausally -- puts [women] in a high-risk category. I'm even a little worried about them ever taking hormones. So certainly for someone who has been on hormones for 3 to 5 years, I'd say give it a good try at trying to get off of it and not just go off cold turkey, do a gradual taper. Do I have proof that works better? No. But for most of us it makes intuitive sense.

UDESKY: Whether you go cold turkey or taper off of hormones the question remains what are the alternatives. Some antidepressant drugs relieve hot flashes, insomnia and mood swings, according to Herr. To prevent heart disease women should make changes in diet and exercise, and, if needed, take drugs to lower cholesterol. For women at high risk for osteoporosis, drugs called bisphosphonates are an alternative to hormones, says Herr. But she warns, women need to steer clear of many over the counter remedies because of lack of evidence that they work or are safe:

DR. HERR: There's sadly an information gap in the over the counter supplements. So the one product that has a fair amount of data is black cohosh. It doesn't act as a hormone, so we really don't understand how it works. We think that women get, depending on what study you look at, quite a bit of relief from black cohosh. Now it doesn't work right away. It takes as much as 12 weeks to get a full effect.

(Fade up sound of women telling their stories just before end of next sentence)

UDESKY: Are there other ways that women can reduce menopause symptoms? Women who are part of a menopause support group come together twice a month at St. Mary's hospital in San Francisco to share information and look for answers:

WOMAN 1: Well I stopped taking hormones three months ago almost to the day. I discovered that all the symptoms that I thought had disappeared reoccurred in full force.

WOMAN 2: I had insomnia, hot flashes: it was ridiculous. I used to have to change my clothes in the middle of the night, it was bad.

(Fade sound down)

UDESKY: Women in the support group have found relief by trying everything from acupuncture and meditation to deep breathing and exercise. Fifty-five-year-old Sarena Levine is a registered nurse and has cochaired the group for 15 years. She's been taking antidepressants and a low dose of natural hormones for four years for menopause symptoms, including migraines. The medication helps, but it doesn't provide overall relief. Instead of increasing her dosage, however, Levine uses acupuncture, vigorous exercise and yoga.

(Midway through ACT I fade up ambient sound of yoga instruction)

LEVINE: One of the symptoms of menopause I've had among others is depression for which I take medication. Yoga helps; it gives me a sense of calmness and well being that's really important in these days of stress. I've also had migraine symptoms and hot flashes and I think that yoga helps with all of these.

(Yoga instruction slow fade down)

Athena Pappas teaches yoga to women at the open door studio in San Francisco.

PAPPAS: Yoga can help by soothing the nervous system. Yoga can also help by cooling the body, so that's one of the main things that the postures that we recommend for menopause are for. So it would either be poses that quiet and calm the nervous system or poses that work on cooling the energy of the body that work on relieving the symptoms of hot flashes, some of the anxiety and tension that comes from that state of menopause

UDESKY: The women's health initiative showed the medical profession, pharmaceutical companies and women that there's no magic pill for preventing menopause symptoms. Even so there are definitely other options. For Consumer Health Interactive, in San Francisco, I'm Laurie Udesky.

First published January 15, 2003
Copyright © 2003 Consumer Health Interactive