Hormones Weather 'the Change'

Three Years After a Landmark Study Hammered Sales, Use of Hormone Therapy for Menopause May Be Inching Up

As president and chief executive officer of the Society for Women's Health Research, Phyllis Greenberger knows all about the studies showing that women who take hormones after menopause have a greater risk of breast cancer, stroke, heart attack, incontinence and dementia. She is aware that federal health officials recommend that the drugs be taken at the lowest dose for the shortest time possible to treat severe symptoms of menopause such as hot flashes.

But Greenberger has no plans to stop taking the hormones she started at age 50 more than a decade ago, although she has reduced the dose. In her case, she said, she doesn't think the advice is relevant. And she believes the risks of the estrogen-progestin combination have been exaggerated.

"I feel better, I have no side effects and in my case I see no downside," she said, noting that estrogen protects against osteoporosis and colon cancer. "Obviously if I thought it was dangerous, I wouldn't be taking it," Greenberger said.

Greenberger's experience is emblematic of a medical landscape that has shifted dramatically since July 2002, when federal researchers made a stunning announcement: Because of the risks to women taking hormones, they were halting a key arm of the mammoth study known as the Women's Health Initiative (WHI) three years early and advising women taking the drugs to consult their doctors.

For decades, despite little evidence of their safety and effectiveness, post-menopausal hormones had been widely regarded -- and aggressively marketed -- as one of the best ways for women to stave off the ravages that accompany age.

The 2002 bombshell was followed by a spate of studies that seemed to systematically strip the remaining gloss from the rosy view of hormones: They don't prevent dementia or memory problems but in fact may increase them; they don't prevent incontinence but may contribute to it; and there is no evidence they improve skin tone, combat wrinkles or blunt mood swings. These findings contravened the gospel drug companies and many doctors had been preaching since the 1960s.

After the announcement, sales of the estrogen-progestin combination drug Prempro, along with estrogen-only Premarin, both manufactured by Wyeth and tested in the WHI, nosedived off the list of best-selling pharmaceuticals. In the months before the WHI announcement, an estimated 14 million women in the United State were taking hormones. Today the number hovers around 6 million.

Even the name has changed. Hormone replacement therapy been renamed hormone therapy (HT) -- the word "replacement" has been dropped.

Despite the scientific sea change of the past three years, it's unclear to what extent clinical practice has been altered, and whether doctors are prescribing the drugs inappropriately or softpedaling their risks.

Some health advocates say they worry that the dangers of hormone therapy may be obscured by the fog of marketing or lingering doubts among doctors about the validity of the WHI's findings.

"There are clinicians who read the data and say the earth is still flat" or insist that their patients are different, said Amy Allina, program director of the National Women's Health Network, a nonprofit educational group located in Washington.

"I think a lot of doctors have been slow to change," said Diana Zuckerman, president of the Washington-based National Research Center for Women and Families. How many women, she mused, are trading relatively short-term relief for a long-term threat like invasive breast cancer?