Pros and Cons of Hormone Therapy:
Making an Informed Decision
LEARNING ABOUT HORMONE THERAPY
Seek Out Reliable Information
Increasingly, making a decision about hormone therapy has come to rest with the individual woman, in collaboration with her doctor, and many women feel unprepared.
Women need reliable information on which to base their decision - ideally, in a form that is appropriate and accessible to their needs. Doctors vary in how much and what kinds of information they provide. Most physician visits are brief, and women often don't have enough time to explore detailed questions or deeper concerns. Some are unsure of the decision even when they leave their doctor's office with a prescription. Surveys show that 20-30% of women prescribed hormone therapy by their doctor never fill the prescription.
There are many useful sources of information about hormones, menopause and approaches to healthy aging, including alternatives to HT; in fact, the amount of information can be overwhelming. Each source of information reflects the different interests, perspectives and approaches of their authors. Sometimes these are clearly stated; other times they are not. It is useful to be aware of who is writing or funding the information.
For example, the pharmaceutical industry has a large economic stake in the research and sale of hormones. There are over 3 million post-menopausal women in Canada and by the year 2010, they will represent 33% of the female population. Women in midlife and beyond are therefore a huge market for new drugs and other products related to aging, including hormone therapy. These products are widely advertised and promoted to doctors and consumers. Women want to be sure that their decision about whether to take hormones is not influenced by marketing strategies, but based on sound research, appropriate to their own situation. (Coney, 1994;)
- Try to read a range of information to have a sense of the debates and issues. Be wary of sweeping statements that sound too good to be true, whether about hormones or complementary approaches.
- If you do not have easy access to a library or other sources, information packages pamphlets and books can be ordered. If you are an Internet user, there are some good women's health sites to explore. It can be helpful for women to meet together to review information and seek answers to the questions they have.
Learn What You Can About the Research
While we know some things about hormone therapy, there is still much we don't know. In trying to make an informed decision, it is helpful to understand what is known from current research, what is uncertain, and what we still need to know, particularly in terms of long term effects.
Many women are reluctant to read original research studies or reports, finding them dry, unclear and intimidating. And most women don't have the time. However, it is possible to read abstracts or summaries of current research and to ask questions of your doctor, pharmacist or health librarian that will help in evaluating how relevant the research findings may be to your situation. To be informed consumers, we need to understand how research shapes medical practices.
Our currently accepted ideas and information about the risks and benefits of hormone therapy are based on many different types of research studies conducted with women in North America and in other parts of the world. The research methods of the studies vary. Some follow the women over several years, other for a longer time. Comparing results among studies that use different methods and populations of women can be tricky. Some studies contradict the results of others; some seem to support previous studies. Researchers and practitioners may differ in how they interpret the same findings, depending on whether they see menopause as a disease or not.
A Few Research Pointers
- Research studies provide information on the particular populations of women studied. Depending on how the studies were done and the size of the populations studied, they may tell us with more or less confidence that hormone therapy is associated with particular benefits or particular risks in that population of women and in women similar to them. When studies are based on small numbers of women, the conclusions cannot be assumed to apply to all women. Most good studies suggest useful directions for further research. They are part of a large puzzle, whose boundaries are not clear and not all of the pieces will ever fit together!
- Studies of large populations of Canadian or North American women tell us some of the characteristics of women who tend to have heart disease, osteoporosis or breast cancer and the chances a woman with these characteristics will have the disease.
- Studies also tell us how common a disease is in a particular population. For example, heart disease and osteoporosis are more common among women as they age than breast cancer. How likely you are to get the disease should be taken into consideration in weighing the benefits and risks of hormone therapy.
- Simply because you have risk factors for a disease does not mean you will get the disease. Or, you may have no risk factors and still get the disease. For example, the majority of women who get breast cancer have none of the identified risk factors.
- Studies do not let us predict which individual women will get these diseases nor who will be protected if they take hormone therapy. However, studies can give us an estimate of the percentages of women who may have a disease in their lifetime without taking hormones and the percentage who may be protected from the disease by taking hormones.
- Research doesn't always tell us exactly what we'd like to know. For example, many women are interested in knowing how HT compares with complementary therapies (such as vitamins, herbs, exercise, etc), but most studies compare taking drugs to taking a placebo or no drugs.
In making a decision about hormone therapy, a woman and her practitioner must take the best research available at the time and apply it to the woman's own situation.
