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There are plenty of alternatives to hormone therapy


Tuesday, July 16, 2002

By Virginia Linn, Post-Gazette Health Editor

For years, women have wondered "should-I or shouldn't I?" when it comes to taking hormone replacement therapy.

Finally last week, the picture became clearer. While the announcement on the abrupt halt to the largest government study on long-term HRT stunned women and scientists alike, it was good to finally have some concrete direction on how to handle this confounding menopause issue.

Virginia Linn
The long-awaited national Women's Health Initiative study on the long-term use of Prempro, the popular combined estrogen (Premarin) and progestin pill showed that short term was better. Use beyond two to five years -- depending on which doctor you talk to -- could increase risk of breast cancer, heart disease, blood clots and other problems.

But this message for short-term use isn't welcomed by all women who have been on this medication for years and say they feel much better on it, than off of it. Early responses from our query on post-gazette.com's health page show that some women don't want to give it up.

Others couldn't tolerate Prempro and its side effects and have been prescribed newer forms of estrogen and progesterone that are a closer, if not an identical match to the hormones produced by the body. Among these are estrogen patches called Estroderm, Climara, Vivelle and a pill, Estrace, which replenishes a form of estrogen called estradiol.

Alternatives to progestin include the topical creams Progest or Emerita, as well as a pill, Prometrium.

Women also have turned to local compounding pharmacies to blend natural plant hormones identical to those in a their bodies. We presented a package of stories on these alternatives in Your Health on May 28.

While a pharmacy consultant and several doctors assailed our article on the compounding pharmacies, saying that these products were not regulated by the Food and Drug Administration and it's unknown what goes into them, I know several women taking these so-called "bioidenticals" who have nothing but praise for them.

The big question is whether these alternatives will pose the same long-term, increased risks of breast cancer, blood clots and heart disease found in the Women's Health Initiative study.

Until similar studies are done on alternatives, some doctors argue they also should be prescribed for a short time. As for long-term health, there are cholesterol-lowering statins to prevent or manage heart disease, and medications such as Fosamax or Evista to keep bones strong.

We should also consider our lifestyles. The speculation about why earlier observational studies of Prempro showed all sorts of benefits to the heart, mind and bones was that the women who initially took the medication tended to be more health-conscious to begin with. They exercised, they were lean, they watched what they ate, they didn't smoke and they were interested in taking hormones because they were just more aware of health issues.

Based on those early studies then, researchers and doctors pushed the use of HRT, claiming it would help women live longer and be more active.

So maybe its wasn't the estrogen drugs that were keeping these original users young, but the way they lived their lives.

How our Noni juice test went

Here's an update on our own in-house test of Tahitian Noni juice, that much-touted health drink that is reputed to ameliorate any number of ills, from high blood pressure to obesity to gastrointestinal problems.

A Post-Gazette staff member drank an entire case of Tahitian Noni juice -- four bottles -- over a period of about two and a half months. She followed directions faithfully, drinking, on average, four ounces a day first thing in the morning, waiting at least 30 minutes before consuming anything else.

The result was inconclusive. The staff member, who has been treated for ulcerative colitis, said she felt better -- but wasn't sure if it was due to the Noni juice or the prescribed drug she had been taking. Otherwise, her blood pressure, which has always been low, was actually found, in a routine doctor's visit during that time, to have edged up into the "normal" range. And her weight problems remained problematic.

In sum: the Noni juice may have helped her gastrointestinal problems, but then again, it may not have. Clearly the results of one case is not definitive -- that won't happen until a randomized, clinical trial is done in a study involving thousands of participants.

For more background, read our earlier report on noni juice.

Your Health editor Virginia Linn writes about consumer issues. You can reach her at health@post-gazette.com

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