The dream of doctors and patients is to find a treatment for an illness with all benefits and no harmful side effects.
This may not be an impossible dream. In 1998, a revolution in hormone replacement therapy (HRT) began when raloxifene was introduced as the first Selective Estrogen Receptor Modulator (SERM). SERMs and other synthetic hormones, known as designer estrogens, have the potential to provide the positive benefits of HRT, without many of the negative side effects.
What are SERMs?
SERMs are synthetic drugs that act on estrogen receptors in different tissues. In clinical trials, SERMs have prevented bone loss and lowered serum cholesterol levels, without increasing the risk of endometrial cancer. Raloxifene, a SERM that is FDA-approved for both the prevention and treatment of osteoporosis, does not appear to increase the risk of breast and endometrial cancers. Thus, it is hoped that raloxifene may retain the beneficial effects of estrogen, while eliminating the associated risk of these cancers.
Research in the effectiveness of raloxifene and other SERMs for menopausal symptoms is currently being conducted. The results of these studies may help to clear the current cloud surrounding the HRT question.
The HRT question
Last July, the National Institutes of Health (NIH) study, “Women’s Health Initiative” (WHI), the first large-scale, randomized, controlled clinical study of HRT, was stopped early when it was found that health problems were worsened by HRT, outweighing any benefits to symptom relief (i.e., relief from night sweats, vaginal dryness, hot flashes) for menopausal women. WHI found that taking estrogen plus progestin, a traditional form of HRT, may lead to an increased risk for heart attacks, strokes, blood clots, and breast cancer.
Given the recent negative media attention surrounding traditional estrogen replacement and the resulting uncertainty regarding HRT, menopausal women are left with questions and confusion. So, should meno-pausal women consider some form of HRT?
It’s an individual choice
“Certainly, the past recommendation that all women take HRT indefinitely, to promote their long-term health, should stop,” says Ken Muse, M.D., associate professor, Department of Obstetrics and Gynecology, University of Kentucky College of Medicine. “Independent expert committees have reviewed these results and made no overall recommendations; rather, they decided that HRT use should be decided upon individually by patients, after being given all the pertinent information by their doctors.”
So, women should discuss these findings with their physicians and decide if HRT is beneficial to them. Some patients may quit HRT altogether. Those on HRT to prevent certain health problems may need to consider other treatment options, as few patients will get benefits from HRT that they could not get from other therapies. These other therapies may come in the form of designer hormones such as SERMs.
Designer hormones or traditional HRT?
“Women concerned with preventing osteoporosis might be better served with alternative therapies, such as SERMs and other designer hormones, as well as lifestyle and dietary modifications, rather than traditional estrogen replacement,” says Muse. “Women focused on heart disease and stroke prevention should work on lifestyle, blood pressure, and cholesterol issues, and HRT should be dropped.”
A more complicated decision will come in women taking HRT to treat symptoms of menopause, such as hot flashes, night sweats, vaginal dryness, and mood changes, for which there are no equivalent therapies. The quality of life improvement they get is usually only obtained by taking HRT.
“In a few years, newer versions of HRT, without many of the above drawbacks, such as SERMs, will be available,” says Muse. “It appears that HRT will evolve and continue to be an important part of the routine health care of menopausal women.”