Stop Taking Prempro, Doctors Warn

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http://content.health.msn.com/content/article/1825.51088

Stop Taking Prempro, Doctors Warn

Estrogen/Progestin HRT Linked to Breast Cancer, Heart Disease, Stroke

By Daniel DeNoon

July 9, 2002 -- Women should stop taking a popular form of hormone replacement therapy (HRT), doctors warn. The warning applies to Prempro as well as to other oral, high-dose combinations of estrogen and progestin.

A huge clinical trial of Prempro -- the Women's Health Initiative -- came to a screeching halt on May 31. Plans to continue the trial until 2005 have been scrapped. Five-year data show that Prempro increases a woman's risk of breast cancer, heart disease, and stroke. The trial predicts that one in 100 women will have a bad outcome from long-term Prempro use. These risks are small, but they outweigh the drug's benefits of reduced hip fracture and colon-cancer risk. The study results and an accompanying editorial were released early and will appear in the July 17 issue of The Journal of the American Medical Association.

The editorial advises doctors to stop prescribing combination estrogen/progestin HRT.

"The whole purpose of healthy women taking long-term estrogen/progestin therapy is to preserve health and prevent disease," write Harvard cancer researchers Suzanne W. Fletcher, MD, and Graham A. Colditz, MD, DrPH. "The results of this study provide strong evidence that the opposite is happening for important aspects of women's health, even if the absolute risk is low. Given these results, we recommend that [doctors] stop prescribing this combination for long-term use."

Robert Bonow, MD, president of the American Heart Association, agrees with this opinion.

"The American Heart Association advises that women do not start or continue combined HRT for the prevention of coronary heart disease," Bonow says in a news release.

Many women take HRT to relieve the symptoms of menopause. Might short-term treatment bypass the risks? The study wasn't designed to answer this question -- but it offers some relevant information. Study co-author Ross Prentice, PhD, is director of the Fred Hutchinson Cancer Research Center's Public Health Sciences Division, Seattle. "We did see evidence of increased risk of coronary heart disease quite early," Prentice tells WebMD.

"If Prempro is used for the relief of menopausal symptoms, the time period should be as short as possible. Or a lower dose may be appropriate for some women."

Another part of the Women's Health Initiative continues. This study looks at the use of oral estrogen alone -- Premarin, the second most commonly prescribed medicine in the U.S. Because estrogen alone increases a woman's risk of uterus cancer, the long-term Premarin study enrolls only women who have had a hysterectomy (removal of the uterus). Prentice says that women in this trial are being sent letters assuring them that, so far, there is no significant evidence of an increased risk of breast cancer with Premarin.

The authors of the study note that the findings may not apply to other HRTs. Low-dose estrogen/progestin combinations may be safer, although further study is needed. Transdermal HRTs use a patch to slowly release hormones into the skin. These may also be safer. Prempro uses progestin, which is a man-made hormone. The patches use progesterone, the natural hormone. And the patches slowly let hormones seep into the bloodstream, bypassing the digestive system and the liver.

This is more like the body's normal way of releasing hormones. Again, more study is needed. © 2002 WebMD Inc. All rights reserved.

-- Anonymous, July 09, 2002

Answers

I take the synthetic form of HRT at the lowest dose possible to zap hot flashes. My hot flashes were debilitating--couldn't sleep more than a couple of hours at a time, would suddenly start dripping sweat at the checkout, very embarrassing. I figure lack of sleep will kill me long before a coronary.

-- Anonymous, July 09, 2002

Just so that you're aware that HRT may cause cancer in some women, OG. It's every woman's choice as to what to do. We think it causes early breast cancer in my family.

-- Anonymous, July 09, 2002

I am on just estrogen, have been for 24 yrs. stopped for awhile..and WON'T do that again...will tell you women what happened, but too personnel for the guys!

was on the combo, but got very sick with it...so stopped that after just a few weeks.

-- Anonymous, July 09, 2002


I think you have to fine-tune HRT for everyone who takes it. It took a bit of tinkering to get mine about right and the doc checks me out once a year with a thorough physical (it was every six months for a while) and really gets on me to get a mammogram every year. It all boils down to sleep, it really does. My sleep is screwed up anyway but with the HRT I can sometimes sleep 6-7 hours at a time. You have no idea what a difference it makes. Yep, I worry about the cancer aspect, especially since both my parents died of cancer, but I might not make it to my 70s if I don't get my sleep!

Like SAR, I quit the HRT every now and then (but I taper the usage over a week or two), just to see if my body has quit screwing around with the hormones, but no luck so far.

SAR, are you taking an aspirin each night too? I take it at night because most heart attacks occur in the middle of the night. The doc is very insistent on that too.

-- Anonymous, July 09, 2002


no, don't take an aspirin, Dr. hasn't told me that yet, but are you taking real aspirin, or a baby aspirin, or what..I haven't been, thinking I don;t want to get used to it, then NEED pain relief and be ammuned. Remember I get those terrible headaches, and they I take pain pills. But...taking an aspirin just might help me sleep, too, I have a hard time sleeping at night, so when i get a run of good nights sleep, I appreciate it!

-- Anonymous, July 09, 2002


I usually take a regular aspirin because I forget to pick up the baby aspirin. Sometimes I'll sit down and use the pill cutter to halve them but more often than not I just don't bother. I don't think you can get immune to aspirin's pain-reliving qualities. I haven't yet. Be warned, though, ibuprofen can negate the effects of aspirin. I take ibuprofen in the morning so I can walk without creaking. (Another reason to take the aspirin at night.)

-- Anonymous, July 10, 2002

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