Hormonal treatment / harmful or beneficial?
By Yuval Dror
The US National Institutes of Health (NIH) recently stopped an experiment that lasted more than seven years, with the participation of thousands of menopausal women, who took the hormone "estrogen". The experiment was stopped when it became clear that women who took estrogen were more vulnerable to stroke. to stop the experimental arm. A year and a half ago it was decided to guide the women who were treated with hormonal treatment that combines estrogen and "progesterone" (the so-called "Permapro"), to stop taking it after it became clear that the treatment increases the chance of getting breast cancer.
The experiment was conducted by the American organization "Women's Health Initiative" (WHI). It started in 93, when 16,806 women aged 79-50 were examined. The group was randomly divided, so that some were given Paramepro, some were treated with estrogen only and some were given a dummy drug (placebo). The distribution of the drugs was given in such a way that neither the women who took the drugs nor the doctors who examined them knew what hormonal treatment they were receiving, if any. Women who take estrogen are women who suffer from menopausal symptoms and have had a hysterectomy. Women who have not had a hysterectomy should take the combined treatment of estrogen and progesterone.
In July 2002, the WHI published a study according to which women who take the composition Parampro (0.625 mg of estrogen, which is produced from the urine of pregnant mares, and about 2.5 mg of progesterone), increase their chances of getting breast cancer if they take it for five years or more. As a result, the experiment was stopped among the group that received the treatment. In June 2003, additional results of the study were published in the American Medical Association Monthly, from which it became clear that already in the first year of treatment, cases that could develop into breast cancer were discovered. In addition, it turned out that when a tumor was diagnosed - it was discovered at a more advanced stage and was larger than the cancer discovered in women who did not take the composition. Later voices were heard claiming that the decision to stop the experiment was wrong and caused hysteria among the women.
Now, the NIH decided to intervene in the trial once again after it became clear that among the group of women taking only estrogen there was a different kind of risk: for every 10,000 women who took the treatment, eight more women suffered a stroke - compared to the control group. The NIH did not release the absolute number of women who participated in the trial and suffered a stroke. And yet, this addition caused the organization to send letters to the 11 women remaining in the trial, instructing them to stop taking the estrogen (or the placebo).
According to Prof. Berry Kaplan from the Faculty of Medicine at Tel Aviv University and the Deputy Director of the Center for Women's Medicine at Billinson Hospital, the full results of the study will only be published in April. "The experiment began to test whether the hormonal treatment prevents heart disease. The researchers found out that there is no connection between the treatment and heart disease for better or worse. Among the group that took estrogen it turned out that there was an increase in strokes but a decrease in the number of colon cancer cases and the number of fractures as a result of calcium leakage (osteoporosis) - Compared to the control group, there was no difference between the groups in terms of the chance of getting breast cancer."
Indeed, Barbara Elbing, director of the WHI, told the American media: "The women should not understand the letter as a special emergency message, but the message is clear: you should not take hormone therapy to prevent heart disease."
According to Prof. Kaplan, the NIH's decision is not as dramatic as the decision a year and a half ago to stop the Parampro trial. "In the past, there were doctors who claimed that estrogen should be taken to prevent heart disease. There were even those who recommended the hormone even to women who did not suffer from menopause symptoms on the grounds that the hormone is good for their health. Today it is clear that estrogen should only be taken for the period when the woman suffers from the symptoms and then the treatment should be stopped."
In Israel: educated women prefer hormone therapy
Dr. Eitan Parr, director of the menopause clinic at Rambam Hospital, and secretary of the Israeli Association for Menopause in Women estimated that until the "NIH's" decision to stop the experimental arm of the "Pampro", about 20% of women in Israel were undergoing treatment Hormonal. "Following the publication, about 60% of the women stopped the treatment. Since then, about half of them returned to taking hormones due to their contribution to the quality of life." Parr added that about 17% of women do not suffer from menopause symptoms at all compared to 14-12% of women who suffer from the symptoms regularly. The rest of the women suffer from the symptoms for a period ranging from nine months to four years.
The symptoms are sleep disturbances, mood swings towards depression and irritability, night sweats, hot flashes during the day, vaginal dryness, loss of vitality, lack of energy and joint pain.
Parr said that taking hormones among menopausal women in Israel is directly related to income and education; The higher the income and education the women have, the more likely they will choose hormone therapy. According to him, the study indicates that there is no connection between estrogen and breast cancer or heart disease and that the increase in the number of women who have had a stroke among those taking estrogen is negligible.
Recent studies
Permepro use increases the risk of breast cancer
Estrogen use increases the risk of stroke
Hormone therapy does not prevent heart disease
Estrogen reduces the risk of colon cancer
Estrogen reduces the risk of osteoporosis
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