By
Linda Carroll, Medical Tribune News Service
Doctors may have a new option for postmenopausal women who shun
hormone-replacement therapy (HRT) because of uncomfortable side
effects.
Researchers
have found that they can reduce headaches, breast tenderness and
other side effects by cutting the estrogen dose in half and giving
women progesterone twice a year, rather than monthly. The lower
levels of hormones still control menopausal symptoms, according
to a report to be presented at the American College of Obstetricians
and Gynecologists in Philadelphia on Wednesday.
In
a study of 138 women over age 54, low-dose estrogen therapy cooled
hot flashes and blocked night sweats, reported lead researcher
Dr. Bruce Ettinger, a senior investigator at the Kaiser Permanente
Medical Care Program in Oakland, Calif.
Ettinger
said that he and his colleagues still need to find out whether
taking progesterone only twice a year is safe. The monthly progesterone
dose is included in traditional HRT in order to protect the uterus
from the cancer-causing effects of estrogen.
Many
women stop taking estrogen because of discomfort caused by the
hormone, or because they are unhappy with the bleeding caused
by the monthly progesterone dose, a researcher unaffiliated with
the new study said.
Even
though women know that long-term HRT can reduce the risk of heart
attack and hip fracture, as many as 80 percent stop filling their
prescriptions after three years, said Dr. Robert Rebar, professor
and chairman of the department of obstetrics and gynecology at
the University of Cincinnati College of Medicine. This makes research
into the viability of lower doses very important, Rebar said.
In
the new study, Ettinger and his colleagues asked women who had
been taking standard HRT to switch over to low-dose estrogen and
twice-yearly progesterone. The California researchers determined
that the new regimen worked just as well for quelling menopausal
symptoms as the standard therapy in about 90 percent of women.
``There was a slight increase in hot flashes in about 10 percent
of the women,'' Ettinger noted.
The
researchers also found that most of the women had no bleeding
between their twice-yearly doses of progesterone. Another 5 percent
had only light spotting, and 4 percent said they had a heavy period.
``This was a very big surprise,'' Ettinger said. ``It's an exciting
and important finding.''
To
determine whether taking progesterone twice a year will protect
the uterus, Ettinger and his colleagues plan to compare uterine
tissue samples taken from the women at the beginning of the study
to samples that will be collected after the women have been on
the twice-a-year regimen for 12 months. The data from this part
of the study will be available early next year, Ettinger said.
Hormone
replacement therapy is linked to a slight increase in breast-cancer
risk, and Ettinger said that it's possible that lower doses will
reduce this increased risk. But it may be many years before researchers
know whether women who take low-dose estrogen will fare better
in terms of breast-cancer risk than their counterparts receiving
standard doses, he added.
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