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Hormones not needed by most women for menopausal symptoms

Thursday November 17, 2005

Hormones Not Needed by Most Women for Menopausal Symptoms; While Effective, Risks Outweigh Benefits for Most
Best Buy Drugs project compares pills, patches, creams and vaginal rings

(Washington, D.C.) – Medicines containing the female hormones estrogen and progestin are highly effective at reducing the symptoms of menopause. But risks associated with taking them outweigh the benefits for most women, according to a new report from Consumer Reports Best Buy Drugs.
Consumer Reports Best Buy Drugs is a grant funded public information project administered by Consumers Union. The menopause report is available free at www.CRBestBuyDrugs.org. It is the latest in a series of reports that compares commonly used prescription drugs on effectiveness, safety and price. All reports are available free on the site.
Studies evaluated for the Best Buy Drugs report show that between 70 percent and 90 percent of women who have hot flashes or night sweats experience an average 75 percent reduction in these symptoms within a few months of taking hormones medicines. The drugs also effectively reduce vaginal dryness and help with sleep disturbances.
Hormone treatment, however, increases the risk of heart disease, breast cancer, blood clots, stroke, urinary incontinence and dementia. Although the increased risk is relatively small, it adds on to already existing risk factors for tens of millions of women. For example, a woman who has high blood pressure and diabetes is already at elevated risk for heart attack and stroke. Taking hormones adds to that risk.
Similarly, a woman who has high cholesterol and a family history of early heart disease and breast cancer would add to existing elevated risk if she took hormones.
For that reason, the report recommends that the vast majority of women who have an elevated risk of heart disease, stroke, or cancer of the breast, ovaries, or uterus not take hormones. This represents 35 percent to 50 percent of all women aged 50 and older.
In addition, studies show that while 70 percent of women entering menopause will have some symptoms, most will have mild symptoms that can be managed with lifestyle changes and adjustments. Only about 20 percent of women have severe symptoms that significantly disrupt their lives or reduce their quality of life.
The reports states for such women, hormone treatment may be warranted. Treatment should be with as low a dose as possible for the shortest duration possible. The risk associated with such use appears to be quite low, but definitive studies on that are not yet complete.
Hormones should not be used at all, the report says, to treat mood swings, irritability, depression, anxiety, mental lapses, forgetfulness, cognitive difficulties, reduced libido, urinary incontinence, back pain, chronic pain, joint pain, stiffness, or fatigue. They don’t help these conditions and could make them worse.
The report also recommends caution in using herbs, supplements, and “bioidentical” hormone products as alternatives to estrogen and progestin for women who do require treatment. These products are widely touted but lack proof of effectiveness and safety.
Taking effectiveness, safety, the choice for mode of delivery, and cost into account, the reports chooses the following as Consumer Reports Best Buy Drugs for treating menopausal symptoms:
Generic estradiol pills
Gynodiol pills (estradiol)
Estratab or Menest pills (esterified estrogen)
Generic medroxyprogesterone pills (when a progestin alone is needed)
Generic estradiol patch
Alora patch (estradiol)
Vivelle or Vivelle Dot patch (estradiol)
Premarin Cream (conjugated equine estrogen)
Ogen Cream (estropipate)
FemRing (estradiol, vaginal ring)
Estring (estradiol, vaginal ring)

Most of these products are used to treat all menopausal symptoms. The creams and FemRing are used primarily to treat vaginal dryness.
All the Best Buys are as effective as other hormone drugs, but less expensive. In particular, the two estradiol pills could save consumers $300 to $450 a year out-of-pocket compared to brand name Premarin. Similarly, the generic estradiol patch could save women $200 to $400 a year over higher-priced products.
The menopause report is based on an independent, scientific review of available medical evidence by the Drug Effectiveness Review Project, a 14-state initiative based at the Oregon Health & Science University. The initiative compares drugs on effectiveness and safety for state Medicaid programs. Consumer Reports Best Buy Drugs combines those reviews with available medical and pricing information to identify Best Buys in each category.
Consumer Reports Best Buy Drugs is designed to help patients – in consultation with their doctors – find effective, safe and affordable medicines. The project is supported by the Engelberg Foundation, a private philanthropy, and the National Library of Medicine.
CRBestBuyDrugs.org has recently been revised. It now contains downloadable summary versions of drug reports in Spanish and English as well as other materials prepared originally in print for the project’s outreach campaign. In addition, the revised site offers initial guidance to Medicare beneficiaries now faced with choosing a drug benefit.
Additional information on the treatment of menopause can be found at Consumer Reports Medical Guide (www.medicalguide.org). This is a subscription-based online tool with rich content for non-subscribers as well. It provides information on more than 60 common and chronic medical conditions.
Susan Herold: (202) 462-6262