Breathe. What you need to know about asthma and HRT
If you suffer from asthma, you will want to take note: researchers presenting at this week’s European Respiratory Society AnnualConference have shown that female asthmatics have an increased risk of landing in the hospital if they take hormone replacement therapy (HRT). Yet another nail in the HRT coffin, once again demonstrating that the health risks of taking hormone replacement may outweigh the benefits.
Notably, studies have shown that asthma risk increases in women after puberty. Moreover, hormones, most specifically fluctuating estrogen levels, can impact airways as much as allergies and hay fever (fluctuating estrogen levels can produce an inflammatory response and exacerbate breathing difficulties). On average, asthma symptoms develop in about 21% of menopausal women and more than twice as many using hormone therapy.
In this study of over 23,000 Danish women with documented asthma, researchers looked specifically at hospitalizations for severe reactions. They also collected information on smoking, exposure to smoke, body mass index, level of physical activity, history of hysterectomy and use of HRT. The findings? Using HRT increased the risk for hospitalization for severe asthma reactions by as much as 40% compared to not using hormone therapy. What’s more, the longer the women used HRT, the higher their risk of ending up in the hospital; for example, if they used it for less than 3 years, they have a 29% increased risk and if they used it for more than 10, a 51% increased risk. Even more troubling was the fact that women didn’t smoke appeared to have the highest risk for being hospitalized in association with their HRT use.
Although this isn’t a randomized trial, and more information is needed, the researchers still recommend that practitioners be made aware of these findings. They say that the relationship between asthma and female sex hormones is hardly new, but that their findings confirm the relationship and further our understanding of it by showing the extent of severe asthma reactions that occur when women take hormones. “If a patient develops asthma or has a severe worsening of symptoms after taking HRT, they may need to stop hormone therapy altogether,” they add.
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Managing menopause naturally
Anyone who is a regular reader of this blog knows that my goal is to explore and identify effective strategies to manage menopause and midlife challenges, strategies that don’t necessarily involve pharmaceutical agents. However, although I am strongly in favor of an integrative approach to health, I am the first to recognize that drugs and certain alternatives, e.g. herbs, are not incongruous but rather require informed decision making. What I don’t support, however, is disease mongering; as greater numbers of women enter menopause, they are increasingly becoming a target for the ‘Menopause Industrial Complex,’ a term that I believe applies to any organized effort to provide women with agents to combat the aging process and highlight the need to use them. In this case, informed decision making becomes a rather misinformed mess.
Speaking of misinformed messes, do you recall Hot Flash Havoc, which I characterized as ‘an infomercial of menopausal proportions, a messy mash-up of HRT hype and fear and loathing, a big estrogen dildo just waiting for an opening?’ Truly, this film made me lose faith in ways I never thought possible. Fortunately, however, everything that is so very wrong with Hot Flash Havoc is so very right with Managing Menopause Naturally, a new documentary that is slated for release on September 27.
Admittedly, I was skeptical going into the screening of this film. And fully convinced coming out of it that Managing Menopause Naturally achieves everything that Hot Flash Havoc did not. If there is a menopause goddess, she is lurking in a variety of MDs, nutritionists, midwives and academics, including those featured in this film, who believe that informed decision making lies with fair balance and choice and not with fear and self-loathing.
Managing Menopause Naturally takes the stance that postmenopausal women are no more estrogen-deficient than young girls approaching puberty and that contrary to public opinion, women going through menopause have plenty of hormones but at a lower level than their reproductive years. In fact, as Aleida LLanes-Oberstein (an RN and Board member of the New York State Midwifery Association) says, menopause is nature’s way of helping a woman move into a less stressful part of her life, to be free of childbearing and rather, nurture herself and her extended family. What an opportunity instead of a death sentence! Moreover, Western culture that has become desensitized toward this transition into another period of a woman’s life, a vision that is a far cry from Eastern cultures that believe that menopause is a period in a woman’s life where blood, fluid and hormones are directed inward for a woman to use for herself for revitalization and healing.
The film offers up current knowledge and education, not just about a woman’s anatomy but also about societal constructs, pharmaceutical and non-pharmaceutical strategies and generational distinctions. It provides a context for menopause, following a historical trail peppered with respectful humour and anecdotes. It is thorough, well-researched and challenges the viewer to challenge the status quo, place menopause within the context of an entire lifetime, acknowledge that there is no single correct path to follow and to make choices based on personal preference and need, as well as community knowledge. This is especially important notes one of the film’s experts, Tierona Low Dog, an MD and midwive and Director of Botanical Medicine at the University of Arizona Program of Integrative Medicine, particularly in the context of where we are today with hormone replacement. “If we start to use community knowledge, menopause and the issues surrounding hormone replacement therapy will be based on educated information and less on dogma,” she says.
In addition to community involvement, the film also points to the need for younger women to start thinking about menopause earlier, an opinion I have long held. Granted, it’s tough to think about menopause and aging in your mid-thirties when kids and family and work and life get in the way. And who wants to think about growing older? Nevertheless, as another expert, Isis M. Medina DC, CCN. Associate Professor at New York State College of Chiropractic notes, “taking measures to take charge early” can alter how the menopause transition plays out. The overriding message of the film is that ultimately, menopause is a personal puzzle that is only partially addressed by hormones, vitamins or other strategies and that that puzzle is a personal one with many data points ranging from lifestyle and geography to diet and culture.
If I have one major criticism of the film, it’s that it is too long, and I suspect that a few viewers will drop off far too early to obtain some of the more important messages that are sprinkled through towards the end. I wish that the editing had been tighter but even after watching it a second time, I’m not sure where I’d cut first; that’s how much I liked the point of view, the honesty and the tone.
Every now and then, something comes along to challenge our inner skeptic, inform our doubts, answer our concerns and help us forge a new path. This film is a gift and I encourage you to watch it.
[Disclosure: I did not receive any compensation to review or endorse this film. However, the marketers did provide me with a free copy of the DVD for my personal review and use.]
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Flaming the fires of HRT: what influences risk?
Let’s face it. Despite my doubts about hormone replacement therapy (HRT), just like the Energizer Bunny, it’s going to keep on going. So as any responsible journalist must do, I have to share the good along with the bad and ugly. The trouble is that data rarely agree, lending confusion to the growing controversy about health risks, appropriate timing, combination and use of HRT.
Last week, several of you sent me a link to a study in the current issue of Menopause that appears to further clarify use of HRT and heart disease risk. Quite honestly, I had seen the study but was hesitant to write about it for fear of simply fueling the fires. But you’ve asked so I’ve answered.
The investigators of this particular study note that experts suspect that timing of hormone replacement, i.e. age when it’s started or time since menopause has begun when it’s started, plays a role in some of the differences between previous reports on HRT and heart disease. For example, reanalysis of data from the Nurses Health Study demonstrates that any heart benefits of HRT rely on starting therapy within 10 years of menopause, while data from the Women’s Health Initiative show that younger age plays an important role as well.
In a quest to tease this out further, they examined information on deaths from ischemic heart disease, age at first and/or current use of HRT, prior use and duration of use in 71,237 postmenopausal women in the California Teachers Study over a period of approximately 9 years. The findings?
- Overall, current age while using HRT appears to influence risk of dying from any cause. This factor appears to be much more importan than age that HRT was started or years since menopause began. Indeed, women using HRT at the time of the study who were younger than 65 years were found to have a 45% reduced risk of death from any cause compared to women who had never used HRT.
- Similar findings were seen when the researchers examined death from heart disease, with HRT providing some protection in younger current users that virtually disappeared once they reached 75 years.
The upshot is that the health consequences and risks of HRT may be influenced most by age at current use, with younger women having the most benefits to gain. Any sort of protection starts to disappear as women grow older so the window of opportunity might be small.
Still, questions remain. These researchers were only trying to determine the most important influencer(s) of death from heart disease and not examining cancer or other risks that have been definitively demonstrated. Do these data fan the controversial fires and serve to heat up the debate? I believe that they do.
As always, buyer beware. Nothing is ever as it seems. Especially when it comes to hormone replacement therapy.
Read MoreDanger! Danger! HRT prescribing lagging behind recommendations
[youtube=http://www.youtube.com/watch?v=RG0ochx16Dg]
Here’s a disturbing piece of news:
Stanford University School of Medicine researchers are reporting that when it comes to prescribing practices, physicians across the country continue to lag behind recommendations from FDA and other organizations cautioning that hormone replacement therapy (HRT) should be used at the lowest dose and shortest period of time possible or only as a last resort. This, despite accruing evidence warning of the dangers of hormone therapy.
While use of hormonal therapy has gradually declined ,some 6 million women continue to place themselves at risk annually. This risk appears to be somewhat exacerbated by the fact that that their doctors, especially ob/gyns, have not changed their prescribing habits very much. Indeed, less than a third of hormone therapy users surveyed in the IMS National Disease and Therapeutic index (which formed the basis for this latest bit of information) were given prescriptions for lower-dose hormone pills, vaginal suppositories or patches. Especially at risk are women old than 60 years in whom the risk/benefit of HRT is very unbalanced, more than a third of whom continue to use hormonal therapy to address symptoms. Thankfully, however, women younger than 50 and up to age 59 appear to be paying attention to the headlines and giving up hormones altogether.
Although the reasons that doctors aren’t paying attention are unclear, the researchers suggest that perhaps clinical practice has not caught up with data or that older women in particular, are satisfied with symptom control and don’t want to rock the boat. Or perhaps many women in this age group remain unaware of the increased risk of heart disease and breast cancer (among others) associated with menopausal hormonal therapy. Regardless, the message isn’t getting through.
How do you change prescribing habits when there’s a breakdown in communications or when study investigators suggest that “it takes a huge event to change clinical practice?” A huge event? I don’t know about you but I think that increases in heart disease and cancer risks are pretty big events. Ladies – it’s time to take this matter into your own hands. Speak up. Work with your doctor, discuss the treatment strategy he or she is recommending and especially when it comes to HRT, ask the hard questions.
Right now, like Robot from ‘Lost in Space,’ I don’t think that we can accept any other course of action other than to take action.
Read MoreHRT – Put up your dukes
Ladies (and gents)…in this corner, weighing in with fear, loathing and disease-mongering, hormone replacement therapy (HRT). And in the other – weighing in as ‘snake oil,’ everything that “doesn’t work,” remains “unproven,” is “unsafe,” hasn’t been approved by the Food & Drug Administration, alternative strategies. Put up your dukes!
Sounds like a boxing match without a referee, eh?
Adding to the controversy are recent study findings showing that Pfizer’s Preempro (estrogen plus progestin) HRT may increase the risk of aggressive, invasive breast cancer and deaths from breast cancer in some women. In fact, the lines continue to be drawn between those who will fight for their hormones no matter what and individuals who believe that either greater regulation is needed or that hormones should be taken off the market altogether. It reminds me of the controversy over mammography, which has been not been proven to decrease breast cancer rates or improve survival. That’s a post for another day, although I encourage you to check out the posts that my friend Marya has written.
The argument against using the Women’s Health Initiative Study (WHI) data to demonstrate the dangers of HRT focuses on the small percentage of women enrolled in the original study who were in the age group (5o to 54 years) when women would be starting hormone therapy. Indeed, research shows that in addition to the type of progesterone added to estrogen, the time on hormone therapy can significantly influence health risks. Moreover, in the WHI, women who took estrogen only were not shown to have increased breast cancer risk (but a heck of a lot other increased risks – just look at the data). And yet, after the WHI hormone study was halted in 2002, substantial declines in the rates of breast cancer were noted in numerous countries, including Canada and the United States. Adding fodder, many pro-HRT experts argue that the alternatives – bioidenticals or complementary medicine – are unproven and downright unsafe.
In case you’ve not been reading this blog regularly, I believe the following and wrote it to a very passionate reader of HealthNewsReview Blog who felt that I was marginalizing women’s suffering:
For decades, women have been duped into believing that menopause is a disease that requires medical treatment, but at the same time, researchers have been unable to differentiate many of its symptoms from those of aging. Consequently, it’s imperative not only to ask what we are treating but why and how.
By all means, if you are comfortable with HRT and other treatments, go for it. But use them with eyes wide open and always examine the risks versus benefits. You might be surprised by what you learn. And how much we still don’t know.
I recently ran across the following statement with regards to the confusion:
“Some things don’t need to be healed; they just need to progress naturally.”
When you’re down for the count, sweating and flashing and swinging without a referee, the call about HRT can be a tough call to make. The good news? Menopause won’t kill you and symptoms do eventually go away. It is just one more of life’s transitions that we have to navigate. Just try to steer yourself towards informed choices and decisions and always, ask the hard questions. There are always those who ‘do,’ and those who ‘don’t.’ Just be sure you’re doing or not for the right reasons.
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