Hormone Replacement Therapy

[Scout]

I have many risk factors for dry eye but for many years (even after LASIK in 1999) the symptoms were manageable.

In early 200l (after my doctor prescribed hormone replacement therapy) the symptoms became extremely painful and unmanageable.

I discontinued the HRT without my doctor’s approval after about 8 months of pain, misery and LASIK complications.

What we know now (that we didn’t know early in 2001) is that hormone replacement therapy for post-menopausal women is recommended only for short-term treatment. With the results from the Women’s Health Initiative Study, we now know that long-term use of hormone replacement therapy can be harmful to women’s health.

There are some studies (even some published after 2001—which is when the dry eye portion of the Women’s Health Initiative study was published in JAMA) that conclude that HRT may be beneficial for post-menopausal women with dry eye. However, those studies involve a small number of patients and the longest I can find is a 12-month study. The WHI study (link to abstract below) lasted four years and involved over 25,000 women with self-report as well as clinical findings.

Each woman is different, of course, and each woman should discuss this with her doctor. In my case, HRT was a disaster for dry eye syndrome and post-LASIK complications, even though I only took it for 8 months (short-term treatment).

I still have many risk factors for dry eye syndrome, but after discontinuing HRT, my symptoms became manageable again.


Link to abstract: http://jama.ama-assn.org/cgi/content...ct/286/17/2114

[Dotanne]

Thanks Scout for your research.
There are some other very interesting articles about hormones and dry eye etc that are listed below the abstract. It would be great to know what they say too. It costs to access them.
I have just come off HRT and have Lasik dry eye but I have been given progesterone cream to help with flushing etc. Maybe that is not a good idea either.

[Gaye]

Hormone replacement therapy

Does anyone know if they are talking about synthetic hormones or the bio-identical ones that supposedly do not have the same risks?

[Scout]

Does anyone know if they are talking about synthetic hormones or the bio-identical ones that supposedly do not have the same risks?

From my understanding of the study, yes, they are talking about the synthetic hormones.

I would highly recommend that any woman over 45 read the study. Information about the study itself as well as links to all the medical journal articles that were written from the study are on the WHI website. The study, in fact, is still going on and will continue to examine and interview the women until 2010.

links: http://www.nhlbi.nih.gov/whi/
http://www.whi.org/

This article about alternative therapies was linked from the WHI website.

National Center for Complementary and Alternative Medicine (NCCAM)
National Insitutes of Health
Consumer Advisory

Alternative Therapies for Managing Menopausal Symptoms

Deciding whether to use hormone therapy (HT) after menopause is a difficult decision many women face as they age. Research has shown that HT is very effective for relieving menopausal symptoms such as hot flashes and vaginal dryness. It can also reduce the risk of osteoporosis. However, there are also known health risks and uncertainties about long-term use. Recent research has demonstrated that long-term use of estrogen--either alone or in combination with progestin--results in more risks than benefits.

Two studies that were part of the Women's Health Initiative, sponsored by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health (NIH), have been stopped because of potential health risks to the participants. The clinical trials were designed to test the effects of postmenopausal hormone therapy on heart disease, bone fractures, and breast and colorectal cancers.

One of the studies included postmenopausal women receiving estrogen combined with progestin. The study found increases in breast cancer, cardiovascular disease, stroke, and blood clots in study participants who were taking this combination compared with women taking placebo pills. This study was stopped in July 2002.

The other NHLBI study, which was stopped in February 2004, involved women taking estrogen alone. After careful review of the data, NIH concluded that estrogen alone did not significantly affect risk of either heart disease or breast cancer compared with placebo. However, similar to the estrogen-plus-progestin combination, estrogen alone increased the risk of stroke.

Both of the postmenopausal hormone therapies tested in the studies demonstrated some benefits, including a decrease in the risk of hip fracture. The combination therapy also resulted in fewer cases of colon cancer. However, on balance the harm was greater than the benefit, and these therapies should not be used to prevent chronic disease. The women in these studies are now participating in a follow-up phase, which should last until 2007. (See the NHLBI Postmenopausal Hormone Therapy Web page under "For More Information.")

Many women may now be considering using alternatives to conventional HT to relieve menopausal symptoms and to lower the risk of conditions such as osteoporosis and heart disease. According to a 1997 study conducted by the North American Menopause Society, more than 30 percent of women use acupuncture, natural estrogen(s), herbal supplements, or so-called plant estrogens (phytoestrogens). At this time, there is not enough scientific evidence to determine whether these therapies are beneficial. In addition, we do not have sufficient information to show whether these therapies are as safe or safer than conventional drugs being used for menopausal symptoms, osteoporosis, or heart disease.

Botanical products containing or acting like estrogens may provide some of the benefits of estrogen in relieving menopausal symptoms. For example, studies have suggested that soy food products can benefit women with mild hot flashes. Some limited research provides conflicting results on the safety and effectiveness of herbal products--such as ginseng, black cohosh, and dong quai--that are marketed for menopausal symptoms. Currently, NCCAM is funding research on several botanicals that have shown promise for reducing menopausal symptoms, including black cohosh, red clover, hops, dong quai, flax seed, and dietary soy.

Through this research, we hope to learn more about the mechanism of action as well as the safety and effectiveness of these botanical products. Studies are needed to define the possible benefits of these botanical products in promoting bone, heart, and brain health, as well as the potential risks of increasing breast, endometrial, or other cancers in diverse populations of postmenopausal women.

Advice to Consumers

* Postmenopausal women should consult their health care provider about their personal risks and benefits of using HT, as well as the use of alternative therapies. Certain lifestyle changes including quitting smoking, eating well, and exercising regularly can also offer benefits and should be considered for promoting healthy aging and reducing the risk of heart disease.


* Alternative therapies may or may not be helpful in relieving menopausal symptoms. More research is needed to define the benefits and risks.


* Herbal therapies may have adverse side effects or exhibit harmful interactions with other medications. Consumers should always discuss their use of herbs and dietary supplements with their health care provider.


* The cost of alternative therapies such as dietary supplements is usually not covered by insurance.


http://nccam.nih.gov/health/alerts/menopause/

[Scout]

This may be a bit off-topic (of dry eyes), however, this most recent article from the WHI study is quite interesting in that it compiled results from all the women who discontinued hormone replacement therapy.

http://www.whi.org/findings/eplusp/symptoms.php

Study Findings
Symptom Experience After Discontinuing Use of Estrogen Plus Progestin
* Abstract of scientific paper in JAMA
* NIH press release
Findings Summary
In July 2002, women in the WHI Estrogen Plus Progestin (E+P) trial were asked to stop their study pills because the overall risks of taking combined estrogen and progestin were greater than the benefits. Soon after, medical guidelines changed to say that menopausal hormone therapy should be used mainly for moderate to severe menopausal symptoms, like hot flashes and night sweats. These new guidelines also said women should take hormones for the shortest time and at the lowest dose possible. Throughout the world, women who were taking hormone therapy began to ask their health care providers about stopping.

Because there was almost no information about what happens when women stop hormones, WHI scientists asked the E+P participants who had just stopped their study pills to fill out a survey about their symptoms and decisions about hormones since stopping. From March through August 2003, surveys were mailed out to over 9,000 E+P participants who stopped their study pills 8 to 12 months earlier after taking them for an average of almost 6 years. Nearly 90% of these women mailed back the surveys.

All of the women knew if they had been in the active hormone or inactive placebo pill group when they filled out the survey, but their data answered some key questions about stopping hormones. E+P participants who stopped their study pills before July 2002 were not sent the survey because they stopped at different times and for many other reasons. These women may have had different experiences when they stopped study pills.

The data analyses focused on symptoms such as hot flashes or night sweats, vaginal dryness, and pain or stiffness. Findings were published in the July 13, 2005 issue of the Journal of the American Medical Association (JAMA), including:

* Women who had menopausal symptoms when they joined the WHI, regardless of their age, were more likely to have these symptoms after stopping study pills than women who did not have symptoms.
* After stopping their study pills, women in the active hormone group reported more symptoms than women in the placebo pill group.
* Women who took hormones before they joined the WHI were more likely to have hot flashes or night sweats after stopping than women who did not take hormones.
* Women tried to manage their symptoms in different ways, including drinking more fluids, exercising, and talking with a health care provider. Most women found these efforts helpful.
* Compared with women who tried other strategies to help with symptoms, fewer women who tried herbal or natural hormones said they helped.
* Very few women started prescription hormones after stopping their study pills.

These findings answer some questions about what happens when hormone therapy is stopped. Women who are thinking about taking hormones for menopausal symptoms should keep in mind that they may have these symptoms again after stopping. More research is needed about how long hormones need to be taken. Women also need more answers about things they can do, other than take hormones, to treat their menopausal symptoms.