 |
|
|
 |
|
Interview with Dr. Bernadine Healy, Physician, Cardiologist, Professor, former Director of the Institutes of Health and former President of the American Red Cross
Page 1
Page 2
Page 3
CBS CARES: Why do women have such different experiences with menopause?
DR. HEALY: Each woman may experience it in different ways because their circulating hormones trail off at different rates.
CBS CARES: Are hormones still produced after menopause, even when the ovaries stop producing them?
DR. HEALY: Yes. Natural hormones are still produced by their bodies outside the ovary by fat cells and adrenal glands. So, before a woman can even think about hormone therapy, the woman has to know how much circulating hormones she already has. There is a big variability there from woman to woman. Women who have more fat on their body versus those who have less fat are more apt to produce more natural circulating estrogen. That partly explains why some women have more symptoms during menopause while others go through menopause without any symptoms whatsoever.
CBS CARES: Are symptoms like mood swings or cognitive problems physiologically based, or are they side effects of poor sleep due to hot flashes and related night sweats?
DR. HEALY: Well, first of all, there is huge variability among women. If you look at one study like the Women's Health Initiative's randomized group and the quality of life analysis, women who were neutral about hormone therapy when they went in claimed absolutely no difference in the quality of life on or off hormones. On the other hand, women who will not give up their hormones are women who will see that when they stop their hormones, they'll have mood swings or cognitive problems.
Having said that, there have been several studies that looked at mood swings or cognitive issues on the same woman on and off hormones. And what these studies have shown is that there is a direct cognitive effect. And some have said it's mainly due to problems sleeping. There's no question that the sleep problem is a real problem. I think the sleep, the hot flushes, the cognitive, and the mood issues are all things that may or may not be related. I've spoken to many women who have said after going off hormones they decided to go back on for mood reasons. These are pretty normal women. They just felt that emotionally they needed to be back on it.
This is the situation where a woman can use her own body. You're not going to harm yourself by taking medication under a doctor's prescription. See if it improves your sleep or not if that seems to be a major problem.
CBS CARES: What do you think of the use of non-hormonal treatments, such as the SSRI class of antidepressants, to treat menopausal symptoms?
DR. HEALY: I don't think it's very important to push SSRI'S as a treatment. I don't know that an anti-depressant is something that's beneficial during this period of hot flashes and mood swings. It's certainly not for all women.
CBS CARES: But it could be beneficial to some women?
DR. HEALY: Yes
CBS CARES: What about sleeping pills if a woman's main menopausal problem is with sleeping?
DR. HEALY: Occasionally, maybe, but sleeping pills have side effects that I think are probably troublesome in and of themselves. Usually, sleep problems will go away over time. We know that as men and women age, their sleeping patterns change anyway. Their biological clock shifts. This is why they tend to get up earlier in the mornings naturally but teenagers can sleep through the alarm clock.
CBS CARES: Who should consider hormone therapy?
DR. HEALY: It varies depending on the symptoms. The most troublesome symptoms are those that relate to the brain and cause sleeping problems and hot flushes or hot flashes, which can be incapacitating. Some women also have cognitive problems like short-term memory issues. It's variable. In certain subsets of women who have severe menopausal symptoms, hormone therapy can be very effective.
CBS CARES: Is there a movement toward using hormones that are closer to what a woman naturally produces before menopause?
DR. HEALY: It's certainly my bias, and I think there is a growing bias, that the more the hormones are biologically similar to what a woman has naturally, the more sense it makes.
CBS CARES: But Premarin, Prempro and other so-called synthetic hormone treatments, continue to be the gold standard of hormone treatment?
DR. HEALY: Premarin is really a mixture of various hormones, mostly estrogens. I think there are a couple of reasons it continues to be used. First of all, it's the most widely used hormone treatment over the past 50 years, and therefore is believed to be safe and effective. It's also inexpensive.
CBS CARES: When you headed the National Institutes of Health, you initiated the landmark Women's Health Initiative ("WHI") Study?
DR. HEALY: Yes
CBS CARES: What did the WHI study involve?
DR. HEALY: The Women's Health Initiative (WHI) of the National Institutes of Health was the first controlled study of any hormone therapy. That's the study I started. All of the data up until then was based mostly on observational studies. And those studies tended to include mostly the self-selective population. The NIH decided to first study the most commonly used estrogen. At the time it was a combination of Premarin, and for women who had intact uteruses, a combination of estrogen and progesterone in a low dose, which was Prempro.
CBS CARES: What was the profile of women who were part of the WHI study and what were the findings?
DR. HEALY: The Women's Health Initiative included over 150,000 women in a controlled trial and an observational trial. The controlled trial included a population of women in their sixties and seventies who had not seen a hormone in years, and were now being put on hormone therapy. These women, who were in the part of the trial where it is a flip of the coin as to whether or not they would be in the group receiving hormones, were women who were completely indifferent to taking hormones. If they were on it, they really didn't care whether they were on it or not. That group also included women who had never had hormone therapy.
When women over the age of 50 were given hormones without any screening to determine if they actually needed hormone therapy, but instead as a sort of universal magic pill, it flunked. It didn't flunk in a major way, but a minor way, showing a slight increase in the number of strokes and heart attacks in a few per thousand. It also showed benefit to the bone. And, as expected, it showed a reduction in the incidence of colon cancer, but an increased risk of breast cancer after roughly five years of being on hormone therapy.
CBS CARES: What about the observational trial?
DR. HEALY: Of the over 150,000 women, almost 100,000 of those women are women who were part of what I called the Framingham Study for Women. In this study the women signed up and followed up with regular blood testing that was set aside for all sorts of analyses including genetic studies. They also filled out questionnaires. The observational trial women were the women who said, "I will not give up my hormones." They wanted to be part of the Women's Health Initiative but they didn't want to go into a trial in which they had a 50 percent chance of not having their hormones. The observational side of the study showed that the women on estrogen had less cardiovascular disease, which is consistent with earlier observational studies.
So, you can argue that they needed different groups of women, and maybe not women whose own natural biological assay was believed to be physiologically better because they are the ones who also happen to have healthier lifestyles and are more health conscious. It could be the hormone therapy, but it might not be. What this means is that it could be a healthy user effect, meaning that the women on hormone therapy tend to have healthier lifestyles to begin with. I mean, they watch their weight, their diets, and in general are more health-conscious, and therefore they do very well cardiovascular wise. But it's not necessarily the hormones that are doing it, it's just their healthy lifestyles and they tend not to have any risks related to hormones.
Page 1
Page 2
Page 3
|
|
|
|
|
|
|
