Hormone replacement therapy (HRT) is still in the news,
but the shock waves from last month's announcements about its dangers
are receding. Already, dismissive comments are popping up here and
there, and you can hear experts hedging their bets. Okay, maybe there's
a little risk, maybe more than we thought. But, hey, even walking
down the street can be dicey, right? What a woman needs to do is weigh
the benefits, talk with her doctor.
I come at this from a slightly different angle. That's
because I view myself as one of those statistics you've read about.
I may be among the additional eight women in 10,000 each year who
developed invasive breast cancer from using HRT.
Of course, no one can be 100 percent sure about something
like that. But consider the facts. I have no known risk factors for
breast cancer. There has never been a case in my family. I did not
menstruate early; reached menopause in my mid-forties; had my kids
before I was 30 and nursed them both. I am neither obese nor a drinker.
Correction: When I was diagnosed last August, I had no risk factors.
Now it appears that I did: I spent nearly 14 years on HRT.
Winking Away Doubts
For me, menopause hit early, with a vengeance, and there's
no question I wanted out; waking up 20 times a night covered in sweat
is no fun. Yes, I do have a few friends who have never had a hot flash,
but the vast majority of women my age whom I know have had plenty.
The "five to seven a day average" that is commonly tossed about is
a joke. Sometimes it feels like one giant flash lasting through the
night. Another joke is the line you hear about symptoms easing off
after a few years. My 88-year-old aunt is still sweating it out regularly.
On the other hand, for most of us, we're talking annoyance,
not life-changing horror. Sure, I was interested in a quick fix, but
not interested enough to do something that would put me in danger.
I was certainly not interested enough to accept the risk -- which
in my case became the reality -- of breast cancer.
Many gynecologists now seem to be acting as if we women
held them up at gunpoint, insisting they prescribe something -- anything
-- to help us out.
That's not how I recall it. What I remember is being
sold a bill of goods.
Prempro, I was told, not only would stop my hot flashes,
it would "keep me juicy" (said with a wink, by a male doctor), and
prevent cervical cancer, osteoporosis, heart disease and quite possibly
even Alzheimer's. Along the way, it just might improve mood, help
memory and enhance life on the planet.
How long did I have to take it, I wanted to know. Yes,
I remember actually asking that question, almost immediately. Even
after hearing the pitch. Not all of us are dying to sign up for years
and years of medication, no matter how wondrous the drug.
Frankly, I've always been a bit pill-phobic. Prempro
is only the second drug I've ever taken for an extended period of
time. (The first was, of course, the pill. More beneficial hormones,
not one of them -- according to every doctor I knew -- capable of
causing cancer.) So as soon as my doctor stopped singing Prempro's
praises, I put it to him: "When can I stop?" He gave me a cheeky grin.
You could see he'd been thrown this one before; he had his answer
ready. "We'll wait 'til you're 90, then we'll reassess," he said.
I've been through a number of gynecologists in the past
14 years. For one reason or another, I've been forced to switch medical
plans at least four times over that period. With every new doctor
-- every year, in fact, at Pap smear time -- I asked again about HRT.
Was it really safe? Should I continue? What about the disquieting
rumors beginning to surface about breast cancer?
Without exception, every one of them urged me to continue.
That's urge, as in strongly encourage, as in no doubt at all, as in
"What is your problem, lady?" The studies were flawed, HRT was totally
safe, especially for someone like me, who had no risk factors for
breast cancer. Of course I should remain on the pills. What was I
thinking?
When it comes to risk, we women are always being told
we need to weigh it against benefits and, of course, consult your
doctor.
They don't tell you what to do when your doctor's guess
is no better than yours.
I'm not blaming doctors for saying HRT was relatively
harmless; after all, it was what they believed, based on the information
they had at the time. I am blaming them for pushing it on us so hard,
as the answer to all our problems. Something you automatically started
taking right around the time that AARP card arrived in the mail.
Both my sisters -- who also hit menopause early -- tried
Prempro briefly, then gave it up. One was horrified at the weight
gain; the other dropped it because of terrible headaches, although
her doctor warned her that without the hormones, she'd need a hysterectomy.
(She switched doctors.) Both have spent the last several years living
with constant hot flashes, which nothing -- not Chinese herbs, acupuncture,
vitamins and tofu -- seems to help. Not pleasant. Not cancer, though.
It made me a bit uneasy that I was the only one in the
family on HRT. How good could it be to take a medication year after
year that basically treated something that wasn't an illness? On the
other hand, two of the smartest women I knew -- one a medical professional
-- were also on it as long. I took comfort from this.
Hollow Miracle
When my mammogram showed a spurt of calcium activity
in my right breast, I was told not to worry, it was probably nothing.
But then the surgeon's tone grew serious.
"You realize, if it is cancer, you'll have to stop taking
HRT," she said darkly.
I didn't want to laugh in her face, but I do remember
passing on the story to friends. Stop HRT? Wouldn't that be the least
of my worries?
As it turned out, I was right. It was. Stopping HRT cold, which I
did two weeks later when the biopsy results came back, plunged me
into a veritable blitzkrieg of hot flashes. Yes, occasionally I noticed
them over the next weeks and months, in between chemo effects. But
it really was the last thing on my mind. I did have other things to
think about.
I realize I'm a lone statistic. Most women, thank God,
will not get breast cancer from extended use of HRT. But there is
a risk, obviously, and it's certainly real enough to take seriously.
One by one, the supposed benefits of this supposed miracle drug have
evaporated. Prevents heart disease? No, in fact it offers no benefit
at all, and may even increase the incidence. Same with stroke. And
blood clots. Alzheimer's? No help there.
Improved cognitive benefits overall? Nope, sorry. Increased
sexuality? No, no measurable effect on libido; it may even make things
worse (according to one study, estrogen squelches any leftover testosterone
in the body, which can affect libido). A shield against depression?
No, again, it may even have a negative effect. Osteoporosis? Yeah.
So they say. If you feel like believing them. (I'm a little wary myself,
right now, but that's my problem.)
And, yes, it does get rid of the damn hot flashes. And
hot flashes can interrupt your sleep and make you cranky. I know,
since mine have shown no signs of slowing down. But putting yourself
at increased risk -- however small -- for breast cancer, heart disease,
stroke and who knows what else just to avoid them? Not a tradeoff
I would have accepted. Had I known.
Judy Oppenheimer is a freelance writer in Washington.
© 2002 The Washington Post Company
