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What to tell your patients
HRT or no HRT
Debilitating symptoms versus the
cancer risk. A guide
to finding the middle way
By Deana Stokes Sullivan
St John's, Nfld gynecologist
Dr Terry O'Grady recalls meeting a woman at a public
forum shortly after the first wave of public controversy
erupted over a 2002 Women's Health Initiative (WHI)
study. The now famous study linked hormone replacement
therapy (HRT) with an increased risk of breast cancer,
heart attacks, strokes and blood clots. The woman was
"so absolutely distraught," Dr O'Grady agreed to meet
with her privately afterwards.
She had a premalignant breast
lesion and several doctors she consulted had refused
to prescribe hormones for her severe menopausal symptoms.
The Ob/Gyn explained all the possible risks. "The patient
said -- and quite rightly -- 'Is it not my risk to take?'"
The HRT storm re-erupted
in January when the Canadian Cancer Society (CCS) recommended
that, "Due to increased cancer risk, women should avoid
combination hormone replacement therapy for any reason
other than to relieve severe menopausal symptoms that
have not responded to any other treatment." For these
women, the Society recommends that the decision regarding
HRT be made with a doctor based on the risks and benefits
of the medication, including: the woman's individual
and family history of breast and ovarian cancer, heart
disease, osteoporosis and dementia; how severe the woman's
menopausal symptoms are; and how long the woman will
be taking HRT.
The Society of Obstetricians
and Gynaecologists of Canada (SOGC) countered by reiterating
its earlier stand that HRT is a safe and effective option
for the treatment of distressing menopausal symptoms.
SOGC is concerned that the CCS may be only adding to
the confusion and fear regarding the use of HRT.
Dr O'Grady is clearly on
the SOGC side. "Sure lots of people will do fine, but
there's a big chunk of women with pretty heavy duty
jobs and heavy duty responsibilities that need something
to get them through." She thinks the CCS conclusion
that women should try other, often untested treatments,
is wrong and possibly even dangerous.
The CCS has based its position
on the original WHI report, which showed a very small
increased risk of breast cancer, less than one-tenth
of a percent for every year of use. Dr O'Grady says
other "overwhelming factors" such as diet, exercise,
alcohol consumption and overall weight were not addressed.
For those determined to stop
using HRT she advises they wean themselves off slowly.
"An awful lot of women say they just can't cope [without
HRT]," says the doctor.
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