Study helps clear up hormone therapy questions

Another day, another hormone study. What is a woman to do? If you are like me, you have either given up entirely on the use of hormone therapy or are baffled by the choices. Is the use of estrogen safe?

I have been writing about hormone therapy for 15 years while researchers have plugged through data available through the Women's Health Initiative, or WHI. The Medical College of Wisconsin was part of that study, so many of you readers are part of this history. This was one of the first major studies for and on women. We now know information that wasn't available without a randomized controlled study that had years of collected data. So why is this still relevant today?

A recent study generated from the WHI research showed us that women who did not have a uterus who used estrogen therapy alone had a 23% decrease in breast cancer. The women who started estrogen around menopause up to the age of 59 also had 46% fewer heart attacks. These women were users of estrogen for at least six years and were followed for 10 years.

Let's look back at where we started. First, there were a number of arms to this study. However, it was the summer of 2002 when women who were using estrogen and the progestin Provera were told to stop their hormones because of the increased risk of heart attacks, breast cancer and stroke. Millions of women dumped their drugs.

In retrospect, the average age of women in this study was 62. Women were started on estrogen at any age. The average age of menopause is 51, so many of these women had been without any exposure to their own body's estrogen for long periods of time.

Also, the progestin used in the study is called Provera, which is a c-19 analog of testosterone. We still don't know if the increase in breast cancer risk might be more attributable to this drug vs. the use of a progesterone (Prometrium), which looks like what our own body makes. There is some evidence from an earlier study called the PEPI trial that Prometrium does have less impact on lipids. This drug was not studied but is now being researched in a follow-up trial.

Then in 2006 we found that women taking estrogen only did not increase the risk of breast cancer. A 2007 review of the WHI data showed that if hormone therapy was started around menopause that it may indeed decrease heart risk.

So now we know there is a difference between women who used estrogen alone vs. those using estrogen and Provera, as well as the difference in what time a woman starts using these hormones.

Effects and side effects of using Depo Provera

Depo Provera is an injection that is used for preventing pregnancy and it shows its effect for three months. This injection is made of synthetic progesterone and is given on the arm, abdomen, or hip and that stops the ovary from releasing the egg and thickens the line of the ovary. The injection has almost all the chances of stopping pregnancy like any other birth control pill. As all birth control pills have their negative and positive effect and so this injection also has its pros and cons. • The injection of Depo Provera is given under the guidance of the doctor at a hospital or clinic. The injection is also packed in such a way that one cannot easily recognize them as such pills. There are some health benefits observed in a woman who used this injection like it has less risk of endometrial and ovarian cancers and very few problems of menstrual periods and cramping. • However, each drug has its effects and side effects and this form of birth control also has some risks. 70% of women who used it have observed effects like weight gain in their first year, and some other effects include headache, mood changes, headache, nervousness, and bloating, decreased interest in sex, hot flashes, acne, back aches, breast tenderness, and hair loss. This birth control injection do not prevent from sexually transmitted diseases like AIDS and HIV.

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