Hormone replacement debate therapy cycles back again

Hormone replacement debate therapy cycles back again

The Women's Health Initiative (WHI), which was stalled earlier because it attributed hormone replacement therapy or HRT with more risks than health advantages, came under flak recently, when a University of Massachusetts Medical Center practitioner held that conclusions of the study were not reliable since the format of the research project was basically faulty.

Dr. Edward L. Klaiber's observations about the WHI were published in the latest issue of Fertility and Sterility.

The WHI was considered a benchmark HRT project because the research team came across results which indicated high risk of breast cancer and stroke for the sample participants, compelling many women to stop hormone replacement therapy (HRT). In 2004, the estrogen branch of the project was halted completely due to these findings. Additionally, the American Heart Association suggested that HRT not be resumed if the hearts of the recipients were to be protected from disease and damage, unless seriously prescribed by a doctor.

Hormone replacement therapy is a process by which women are administered estrogen or estrogen and progestin both to relieve symptoms associated with menopause and has been in existence since the 1950s. It has been believed to be protective against osteoporosis and heart ailments. The 2002 WHI report resulted in many women identifying alternative therapy, one being the bio-identical hormone replacement treatment.

Here, the hormones used are artificially built, yet exactly similar to natural ones and administered as a cream or patch for better absorption. The doses given are customized as per woman's body needs. Supporters of this treatment emphasize that these features of the system provide it more effectiveness than conventional HRT, though the other side proponents disagree with that.

Klaiber's angle of criticism regarding the modus operandi of the WHI has mired the study into fresh debate.

Klaiber has noted that in the estrogen-progestin group, the average age of the women was 63 years, and 73% of them had never undergone HRT previously. In the singularly estrogen group also, the average age was 63 years and amongst them, 52% had never taken prior HRT.

Following this observation, Klaiber's main point of contention is that because the average age of the sample populations was 63, they were as it is vulnerable to heart ailments, apart from their never having had prior HRT. The net resultant approach was thus faulty; HRT for first timers with already existent heart disease or prone to it.

The other main loophole according to him was the section where the researchers used the pill Prempro, having estrogen and progestin both, everyday on the women. Klaiber himself is a proponent of intermittent administration of progesterone. He states emphatically that the “everyday” system of progesterone was not tried and tested for its correlation to breast cancer and heart damage. Besides, before WHI, HRT was a cycle treatment, given 10 or 12 days every month. The use of Prempro in the WHI was seen as convenient since patients did not need to keep track of a second dose. According to Klaiber, if a different type of estrogen similar to the natural body cycle had been used, the results would have been vastly different.

He goes on to assert that HRT when administered in alternative methods than the “everyday” way, pushes up the safety factor and has positive impact on health. He cited the example of the successful Nurses' Health Study, where women were given HRT at ages 40-50 and more so in intervals. That research had clearly established a heart friendly impact of the treatment.

In response to Klaiber's criticism, Dr. Nieca Goldberg, head of the women's cardiac care unit at Lenox Hill Hospital, New York City, said that his analysis was just old wine in a new bottle, minus any substantiation. She added that for a more concrete understanding, perhaps more studies were needed in the HRT direction, a fact to which Klaiber also agreed.

He hopes that the ongoing study by the Kronos Longevity Research Institute in Phoenix will sufficiently prove that HRT is less harmful in younger women just entering menopause and substantiating that it protects the heart in such cases. Till the study establishes anything, administration of estrogen and intermittent progestin are the best solutions.