Study on menopause raises questions.

Byline: JAN STAFL For The Register-Guard

THIS MONTH, SEVERAL front-page reports about menopausal hormonal treatment studies have prompted countless phone calls and visits to women's health care professionals. Many women are again facing the daunting challenge of deciding whether or not to choose hormonal replacement therapy at midlife and beyond.

The Women's Health Initiative study is the largest prospective study looking at the safety, risks and benefits of hormonal replacement therapy. The National Institutes of Health ended the largest part of the study, which was supposed to last 10 years, four years early. Data on more than 16,000 women revealed a significantly increased risk of breast cancer, stroke, blood clot and heart disease after use of Premarin and Provera, the most commonly prescribed hormones, compared with a placebo.

Unfortunately, this study incorporated only the use of an estrogen obtained from pregnant mares (Premarin), and a synthetic progestin (Provera), both of which are not natural to the human body. The use of plant-derived hormones identical to the human natural estrogen and progesterone made by the ovaries (bioidentical) were not studied.

All women received the same dosage and type of hormone.

Other recent studies have shown that lower doses of estrogen than used in this trial can be just as effective for symptom relief. Natural progesterone has been proven to have much fewer metabolic and emotional side effects than Provera. Hormonal patches and creams have a different (and often more beneficial) effect on the body than hormones taken orally, which have to be metabolized by the liver. Short-term use of natural estrogen (less than five years) has helped many women without evidence of increased health risks. In addition, hot flashes, insomnia, vaginal dryness, osteoporosis, and even memory and emotional changes can be relieved by other therapies.

What conclusions can be made about menopausal management at this time? Most importantly, menopause is a natural transition, which does not need to be medicalized. Many women can control bothersome symptoms with dietary changes, such as the use of soy, flax, and reduction of hot flash triggers (sugar, alcohol, caffeine). Vitamins and minerals, especially vitamin E, B complex, and calcium-magnesium are recommended. Herbs like black cohosh, vitex and dong quai are often useful in the short term. Attention to exercise habits (aerobic, flexibility and strengthening), relaxation techniques (meditation, yoga or prayer) and social support is paramount.

If these measures do not adequately relieve menopausal symptoms, testing a woman's own estrogen level, followed by low dose natural hormone therapy, may be considered. To date, hormonal replacement is still the most effective method of preventing osteoporosis, significant short-term memory loss, and emotional lability in estrogen deficient women. Hormones should not be advised solely to prevent heart disease.

All therapies need to be tailored for each individual, including the length of treatment.

Due to the study results, there are even more reasons to limit the use of synthetic pharmaceutical hormones. A holistic approach that considers the physical, mental, emotional and spiritual needs of every woman has been effective and helpful for many of my patients.

Through experience, I have found hormonal management to be only a small part of each woman's menopausal care.

It is my belief that with good information, women will ultimately make the best decisions about the care of their bodies, especially during this transition.

Jan Stafl is a Eugene physician certified in obstetrics, gynecology and holistic medicine.