Women weigh risks, benefits of hormone therapy.

Byline: THE HEALTH FILES By Tim Christie The Register-Guard

For women of a certain age, symptoms such as night sweats and hot flashes can turn life into a sweltering hormonal hell. Treating those symptoms without incurring health risks that outweigh the benefits can present a perplexing dilemma for women and their doctors.

Up until two years ago, hormone replacement therapy - usually some combination of estrogen and Progestin - was a given for aging women. Not only did the drugs relieve menopausal symptoms, but doctors believed - erroneously, as it turns out - the treatment helped prevent heart disease in post-menopausal women.

Then the first Women's Health Initiative report came out in July 2002, finding that the hormones taken by some 6 million American women were doing more harm than good. Researchers found long-term use of estrogen and Progestin increased a women's risk of breast cancer, stroke and heart attacks. The therapy lowered the risk of hip fractures and colorectal cancer, but the risks outweighed the benefits, researchers determined.

Many women quit hormone therapy after the findings came out. Some eventually went back to hormones in desperate need of symptom relief. Others turned to alternative remedies, with mixed results.

A leading expert on hormone therapy, Dr. Isaac Schiff of Massachusetts General Hospital, told doctors last month that it was time for a balanced, analytical debate on hormone therapy.

Hormone therapy remains the most effective treatment for relief of hot flashes, a fact not likely to change soon, said Schiff, chairman of the hormone therapy task force for the American College of Obstetricians and Gynecologists. Still, doctors recommend taking hormone therapy for the shortest time possible at the lowest effective dose.

Schiff and other doctors point out that the WHI study wasn't meant to determine the effectiveness of hormone therapy for treating menopausal symptoms, which is well documented. The study attempted to determine the long-term effects of hormone replacement therapy. Therefore, the average age of women in the combined hormone therapy trials was 63 - more than a decade older than the average age of menopausal women, which is 51.

Most women won't stay on hormone therapy for more than five years, lessening their risk of long-term effects.

Also, 40 percent to 50 percent of women go through menopause without symptoms and don't need hormone therapy at all, said Dr. Cristin Babcock, an obstetrician/gynecologist with Women's Care in Eugene. Among those women who do have symptoms, some decide they can live without hormones. Others start the therapy reluctantly so they can function at work and sleep at night, Babcock said.

Others want to try alternatives, she said.

"Most menopausal women in this area have at least thought about alternatives and many have tried them," she said. "Eugene is more open to those kinds of alternatives."

Dr. Jan Stafl, a Eugene ob-gyn who also is board-certified in holistic medicine, said menopausal women have other ways to attack symptoms aside from prescription and over-the-counter drugs.

Meditation, yoga, prayer, exercise or other relaxation techniques can help women cope with the stress that triggers symptoms, he said.

Stafl also said nutrition can help ease menopause symptoms. He advises menopausal women to avoid caffeine, alcohol and spicy foods. He recommends women eat fermented soy products, such as tempe, miso and soy protein powders, as well as flax seed and fresh fruit and vegetables.

For women who still have symptoms, some may benefit from an herbal supplement called black cohosh, such as Remifemin, a German-made brand of black cohosh, she said.

A member of the buttercup family, black cohosh is a perennial plant native to North America that also is known as black snakeroot, bugbane, bugwort, rattleroot, rattletop, rattleweed and macrotys, according to the National Institutes of Health.

But questions remain about the supplement's safety and effectiveness. Recent studies have linked black cohosh to liver failure, increased risk of breast cancer metastasis, and increased risk of Alzheimer's.

Those reports prompted the Center for Science in the Public Interest to urge the U.S. Food and Drug Administration to warn women about the risks associated with black cohosh.

Dr. John Sobeck, chief of obstetrics and gynecology for Kaiser Permanente Northwest, is skeptical of over-the-counter and nutritional remedies. Black cohosh is probably no more effective than a placebo in easing hot flashes and night sweats.

"They're not well studied for anything but symptom relief, and symptom relief is very subjective," he said.

Tim Christie can be reached at 338-2572.