Wednesday Bubble: HRT? Everybody must get kidney-stoned
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Everybody must get stoned? If you are using HRT, this may be the case. Straight out of the headlines of the American Medical Association’s Archives of Internal Medicine: Healthy women who use HRT may be at increased risk of kidney stones.
You hear about them. But what are kidney stones?
Kidney stones are hard masses the develop when crystals separate out from the urine. Many factors interact to form stone and they are influenced by both genetics and the environment. Although they are often prevented by naturally occurring chemicals before they actually form, when they occur, they can cause extreme pain. Over time, they may actually damage the kidneys. And while kidney stones more commonly affect more men than women up to a certain age, by the time a woman reaches 50, this discrepancy balances out, possibly because estrogen may have a protective effect up until this time.
So, if estrogen is good and protective, what goes wrong when you add it back to the mix?
The findings...In the latest analysis of what is now becoming the infamous Women’s Health Initiative Study, researchers evaluated over 10,000 women in natural menopause who had taken estrogen only (Premarin), estrogen plus progestin (Preempro) or placebo. After an average of 5 to 7 years (depending on which agent the women were taking), women taking hormones, either alone or in combination, had a 21% increased risk of developing kidney stones. When the researchers excluded women who stopped using hormones during the actual trial from the analysis, the likelihood of developing kidney stones increased to 39%. Moreover, study researchers were unable to attribute the increased risk to any other factors, including age, ethnicity, BMI, prior use of hormones or intake of coffee or thyroid medication. Writing in Annals, however, they did note that the way that kidneys stone are formed is complex, and that estrogen may play a role in several stages of that formation and requires further study.
According to the researchers, about 5% to 7% of women reaching menopause will develop kidney stones. My friends over at Reuters health, who did an excellent recap of this study, note that in combination with hormone therapy, this risk increases up to 10%, despite that addition of progestin.
In addition to avoiding hormone therapy, the best thing to do to prevent kidney stones is to hydrate! If you have a tendency to form stones, the National Institute of Diabetes and Digestive and Kidney diseases recommends that you drink enough fluids, preferably water, to produce about 2 quarts of urine a day. Changing your diet can help too: some experts recommend limiting dairy and proteins that are high in calcium. The best thing to do, as always, is to do some preliminary research and then contact your health practitioner.
So getting stoned? How about losing the HRT? Another bubble burst for a failed therapy.
Read MoreNewsFlash: Canadian Cancer Society Recommends Against HRT Use Except as Last Resort
Researchers and representatives comprising the Canadian Cancer Society are recommending that women avoid taking hormone replacement therapy or HRT for any reason other than relief of severe menopausal symptoms that have not responded to other treatments. Wow! Talk about a newsflash!
The reason for last week’s statement is a new study published online in the Journal of the National Cancer Institute that demonstrates an almost 10% decline in the rate of breast cancer among Canadian women between the ages of 50 and 69 following a drop in HRT use.
Utilizing data on HRT prescriptions, incidence of breast cancer, mammography and HRT use in 1,200 women between the ages of 50 and 69, considered primary users of HRT, to a 9.6% decline in the incidence of breast cancer between the years 2002 and 2004. Comparatively, rates during the period of time just before the time studied, i.e. 1998 and 2001, had declined by less than 1%. Incidentally, the more than 50% drop in use of HRT during this time period directly followed reports from the Women’s Health Initiative Study showing a increased risk of stroke, heart attack and breast cancer among users of HRT. Moreover, researchers found that the decline in breast cancer cases were not the result of fewer women getting mammograms; in fact, mammography rates remained stable during this time period.
The researchers say that their results, which are the first in Canada to examine the potential link between widespread declines in HRT use and breast cancer among postmenopausal women, support the Society’s goal of providing Canadian women with information about how to reduce their risk of developing breast cancer. Although the study findings may possibly be limited by the fact that the rely on self-reports of use of HRT and do not take into consieration how often and for how long HRT was used, the researchers claim that the results provide meaningful information on factors that influence breast cancer. Now, they need to determine if HRT promotes or causes breast cancer.
When I asked for a statement from lead study investigator Dr. Prithwish De, he said: “The Canadian Cancer Society’s ongoing review of the evidence on HRT and breast cancer since 2003 led us to our current position and the research study findings reaffirm this position. The Society recommends that women avoid taking HRT for any reason other than to relieve severe menopausal symptoms that have not responded to other treatment. We understand that each woman’s experience with menopause is unique. If, after consulting with their healthcare professional, a woman decides to take HRT, it should be the lowest effective dose for the shortest time possible.”
October is breast cancer awareness month. Educate yourselves and those around you.
Wednesday Bubble: HRT – wait a moment!
Back in early May, I wrote a post about the difficulties in stopping hormone replacement therapy (HRT) and the disturbing fact that doctors have no guidelines to follow in order to advise their patients on the best strategies. Today’s Bubble is a perfect companion to that piece, as it addresses the fact that research now shows that women who start HRT and then stop it have a tendency to have significantly greater and more severe menopausal symptoms than had they never started HRT at all.
Writing in the online edition of Menopause journal, researchers say that among 3,496 postmenopausal women who completed a pre- and post- stopping therapy survey during the Women’s Health Initiative study (a trial that compared estrogen/progestin to placebo and was subsequently halted when HRT was found to double the risk of breast cancer) :
- Those who had not reported having hot flashes at the start of the study were more than five times as likely to report moderate to severe hot flashes after stopping HRT compared with women with no symptoms who took sugar placebo pills. However, women who had reported having hot flashes at the study’s start were only slightly more likely to report hot flashes after stopping HRT
- A similar pattern was seen for night sweats, i.e. women who had none at the study’s start were almost twice as likely to report them after stopping HRT
- Age at stopping HRT was increasingly associated with more joint pain, i.e. the older the woman, the higher the risk for experiencing joint pain
The researchers say that although there have been previous reports of a surge in vasomotor symptoms like flashes and sweats after stopping HRT, these findings show that estrogen, either alone or with progestin, may promote symptoms when HRT is stopped, even if a woman was not experiencing them when she started therapy. More specifically, the risk for menopausal vasomotor symptoms and joint stiffness is four to seven times more in women with and without prior symptoms when HRT is stopped.
The takeaway message is that it’s not only important to consider the health risks associated with HRT but also, what happens when you stop it. Clearly, even if your symptoms disappear while on HRT, your risk for symptoms after stopping therapy is fairly high.
You should always weigh the risk benefit ratio before starting any type of therapy. HRT may not be worth the trouble. Or the multiple risks.
p.s. More on this study from my friends at Reuters Health.
Read MoreIs topical HRT hurting your pet?
File this one under “OMG.” I ran across a piece this past weekend that discussed the effect that topical hormones, particularly HRT, might be having on your pets. Although experts from the North American Menopause Association (NAMS) are quoted as saying that they’ve not heard of this before, the reporter uncovered five years worth of discussion on veterinary internet boards. Evidently, vets are seeing female animal patients with swollen vulvas and male patients with enlarged mammary glands and smaller than normal penises.
It appears that exposure occurs when owners apply topical hormone gels, lotions and sprays to the arms (i.e. elbows, wrists) and legs and then handle or snuggle with their pets. The problem has also been associated with pets unwittingly licking the areas where owners have applied the drugs.
Evidently, the Food and Drug Administration is looking into this as is the NAMS. In the interim, if you are using topical hormones, you might want to be more careful where you apply them (e.g. inner thigh or abdomen) and be sure to wash your hands before handling your pets.
And if your animal is exhibiting unusual signs? Bring them into the vet immediately.
Has anyone encountered this before? I’d love for readers to weigh in.
Read MoreWednesday Bubble: The HRT patch – is it safer?
Remember the diva and the doctor sitting on the roof espousing the benefits of the HRT patch? Well, it turns out that some of these patches might not be so safe after all. Results of a study of over 75,000 women published in the British Medical Journal, show that the use of high-dose transdermal (through the skin) HRT patches increases stroke risk by as much as 88%.
Granted, transdermal or through the skin delivery bypasses the liver, which typically makes patches safer than their oral counterparts. However, if the drug isn’t safe, well, then the patch might not be either.
In this latest bit of news, researchers evaluated women between the ages of 50 and 79 who had participated in the ongoing Study of Women Across the Nation (SWAN). Every woman who had had a stroke were matched for comparison to four women in the study, with similar characteristics, who had not. The women were further divided into groups based on their use and type (i.e. oral or patch) of HRT, including estrogen only, estrogen plus progestogen, progestogen only, and the estrogen alternative, tibolone (which is not available in the US).
The researchers say previous and recent studies suggest that oral HRT, including estrogen only or estrogen plus progestogen, is associated with a 30% increased risk of stroke. However, stroke risk differs between high- and low-dose patches. Overall, they report that:
- Low-dose patches do not appear to increase stroke risk, at least in the short-term (they say that they cannot rule out an increased risk with long-term use)
- High-dose patches, regardless of whether or not they are estrogen only or estrogen plus progestogen, appear to increase stroke risk by anywhere from 25% to 88%
- Risk was the highest among women who had used oral HRT before trying transdermal HRT, although this risk appeared to decline the longer the time period between stopping oral and starting the patch
- Findings remained even after adjustments were made for factors that might influence results, including age
What the findings mean
Despite claims to the contrary, it does not appear that HRT offers much protection against heart disease during and after menopause. What’s more, the HRT patch may not actually be safer than oral HRT, at least in so far as the high-dose HRT patch goes. Although the researchers state that they were unable to distinguish between types of stroke when evaluating the SWAN study data, they say that these data show the need to look further into how HRT is delivered, especially as use of the HRT patch becomes the norm.
As I’ve written previously, if your doctor suggests you try HRT for menopausal symptoms, it behooves you to ask the hard questions. While you may save your sleep, mood and a few articles of clothing, you may be placing yourself at a higher risk for cancer, heart disease and other serious conditions.
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