Hormones Weather 'the Change'

A Quiet Return

While women are not returning to the drugs in droves, there has been an uptick in their use to treat the more troublesome symptoms of menopause. Some of the increase seems to have been spurred by the marketing of new, lower-dose formulations of existing drugs.

Two months ago Wyeth launched a television marketing campaign featuring actress Cheryl Ladd. Best known for her role as one of "Charlie's Angels" in the eponymous television series Ladd, 54, discusses her own experiences with menopause. She never mentions a specific drug but advises women to talk with their doctor about how best to cope with hot flashes, night sweats and osteoporosis.

"There seems to be a very strong interest in low-dose hormones," said Wyeth vice president Natalie deVane, citing recent company data showing that 25 percent of women who stopped taking hormones after the WHI was halted are now back on them. A study by Minnesota researchers published earlier this year in the journal Menopause yielded similar results; it found that women in their fifties were more likely than older patients to stay on HT.

Some gynecologists who switched their patients to low-dose pills say they still believe the benefits for many women with severe menopausal symptoms outweigh the small risks, which they regard as hyped and not necessarily applicable to younger, healthier women. The average age of women in the WHI was 63, they note.

"I think the fear factor has definitely calmed down now -- as it should -- and other points of view have come forward," said Anne Brown, chief of obstetrics and gynecology at Inova Loudoun Hospital.

"I think the WHI has unnecessarily scared too many women," said obstetrician-gynecologist Constance Bohon, who practices near Washington's Sibley Hospital. "I tell patients it's a very specific study" of a single drug at a particular dose and let them decide for themselves.

But women's health advocates say the potential risks apply to women of all ages, not just those over 60. The WHI included women between the ages of 50 and 79, including thousands in their fifties.

"The thing about science is that you can always ask another question -- like, 'What about women who are 49?' " said Allina, of the Women's Health Network. The WHI, she said, remains the scientific gold standard.

Zuckerman points to the latest WHI-related study, published two months ago in the Journal of the American Medical Association, which found that more than half of women who had taken hormones to treat hot flashes and night sweats experienced those problems when they stopped taking the drugs. Some women "are taking a risk with their health with the possibility of just dragging this out," she said.

Other advocates say that one reason women return to HT is that nothing else has been shown to work for severe menopausal symptoms.

"Nobody ever said that women who tried other approaches and had miserable hot flashes and couldn't sleep shouldn't take estrogen" for a short time at the lowest dose, said Judy Norsighian, co-founder of the Boston Women's Health Book Collective, which wrote the landmark feminist guide "Our Bodies, Ourselves." But, she noted, women must be properly informed of the potential hazards.

Earlier this year an independent state-of-the-science panel convened by the National Institutes of Health (NIH) called for the "demedicalization of menopause" and warned doctors and patients to use hormones sparingly. The panel also noted that it is difficult to distinguish between symptoms of menopause, which are usually transitory, and those of normal aging.