CONFUSION FOLLOWS HORMONE WARNING.

Byline: Holly Edwards Staff Writer

Women who have viewed hormone replacement therapy as a cure for everything from menopausal hot flashes to heart disease flooded doctors' offices Tuesday after a new study showed the drugs increase a woman's risk of breast cancer, heart attacks, strokes and blood clots.

Cindy Moskovic, director of the Iris Cantor-UCLA Women's Health, Education and Resource Center, said there has been a constant stream of women stopping by or calling the center seeking advice.

``A lot of women are confused because the study clears up questions and raises more,'' she said. ``I think it clarifies the picture on the breast cancer risk but many unanswered questions remain about the use of hormone replacement therapy to treat other menopausal symptoms.''

While the study by the National Institutes of Health revealed new information about the risks and benefits of the drugs, Moskovic said the decision to take hormone replacement therapy must be based upon each woman's health history and the severity of her menopausal symptoms.

``The key is to customize treatment to fit each individual woman,'' she said, adding that the study clears up questions about the link between estrogen and breast cancer and heart disease, but raises questions about how to balance the benefits of the drugs with the increased risks.

``Estrogen was once viewed as the wonder drug. Now it is every woman's dilemma,'' she said.

While the study's findings have thrown many women into a state of confusion, the information is the first definitive proof doctors have of the link between the therapy and illness, according to Dr. Howard Judd, the head researcher of the ``Women's Health Initiative,'' the study that revealed the risks.

``Until now, doctors have been working in a fog,'' said Judd, a professor of obstetrics and gynecology at UCLA and a staff physician at Olive View Medical Center in Sylmar. ``Now we know there are greater risks and fewer benefits, and I think women will rush back to their doctors to reassess the therapy.''

Though the health risks associated with hormone replacement therapy are small, Judd said doctors must be more cautious with the treatment because it is long term.

``This is not a dangerous medicine,'' he said. ``But we have to set the bar of safety higher because women will potentially take it for half of their lives.''

Some 6 million women nationwide take estrogen and progestin to replace hormones lost at menopause. The drugs have been used for decades to relieve symptoms associated with menopause - such as hot flashes, mood swings and night sweats.

In recent years, the drugs also have been touted as a boon to women's overall health by reducing the risk of heart disease and osteoporosis.

While the drugs are still believed to decrease bone loss, Judd said the study revealed that hormone replacement therapy in fact increases women's risk of heart disease.

Results of previous studies showing a decreased risk of heart disease among women who take hormones were skewed by the very women selected to participate in the studies, Judd said.

``Women who take estrogen in general are healthier and are more likely to modify their behavior by exercising or stopping smoking,'' he said. ``This behavior had much more to do with the decreased risk of heart disease than the hormones.''

In all, 16,000 women ages 50 to 80 participated in the hormone replacement therapy study. After five years, the study indicated the women had a slightly higher risk of breast cancer, heart attack, stroke and blood clots, but a lower risk of colorectal cancer and hip fractures, Judd said.

Though the study was scheduled to continue until 2005, researchers decided to call it off when they determined that the health risks were unacceptable. UCLA was one of 40 centers nationwide participating in the study.

``To have a large-scale trial stopped because of increased health risks is very, very significant to health care professionals as well as consumers,'' Moskovic said. ``Our job is to make sure this information is available to women as soon as it's available to us.''

While the decision to take estrogen has always been a matter of weighing the risks and benefits, Judd said every woman taking the drugs will now have to reassess that balance.

Researchers have not determined why the drugs increase women's risk of breast cancer, Judd said. However, he said, the drugs increase the risk of blood clots, stroke and heart disease by altering the way the body's clotting mechanism works.

``When estrogen is taken by mouth, it goes directly to the liver, and alters the clotting factors made in the liver,'' Judd explained. ``So it is easier for estrogen to cause blood clots in blood vessels.''

While Judd said the study provides the first definitive data on the risks of hormone replacement therapy, he said doctors must mull over and digest the information before reaching a consensus on when to prescribe the drugs.

``Now we know there are greater risks and fewer benefits, so it all has to be reassessed,'' he said.