Return to Transcripts main page

CNN Live Today

OB-GYN discusses HRT

Aired July 24, 2002 - 11:35   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DARYN KAGAN, CNN ANCHOR: Time now to page Dr. Gupta and talk about a controversial subject that has been in the news lately and bring up a lot of questions. Hormone replacement therapy is also known as HRT. The combination of estrogen and progestin is used by millions of women to ward off the signs of menopause.

Recent studies, though, have led to many questioning whether the risks are worth the relief, and we have been getting your questions. Now, we have your answers.

We have Dr. Sanjay Gupta with us, and he has another specialist with us.

But first, I just want to ask you some scientific perspective. This study, looking at this, and we have seven million women across the country using this. But this study, they pulled the plug on it three years ahead of the expected date. How unusual is that?

DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Well, I'll tell you, it's one of those scientific things that if you start to realize that the risks are outweighing the benefits, it is in everyone's best interest, the scientists, and certainly the volunteers in the study, to go ahead and pull the plug.

But, you know, the interesting thing about this story is that I think patients go to doctors and want yes or no answers. Should I take it or shouldn't I take it? As we are finding out, it's really not that easy.

And who better to comment on that than Dr. Lila Nachtigall, who joins us from New York. She is head of the Women's Wellness Center at NYU -- welcome.

It is not really very easy to give a yes-no answer to that question, is it?

DR. LILA NACHTIGALL, NYU SCHOOL OF MEDICINE, OB-GYN PROFESSOR: Absolutely. It's so individual. It depends on the individual woman's risk and the individual woman's benefit. So you can't go by a large population, and that's why women have so many questions.

KAGAN: And -- go ahead.

GUPTA: And as I say, there are lots, and we have gotten tons of questions already, Daryn. You can...

KAGAN: Get started on those...

GUPTA: ... begin to read all of those, yes..

KAGAN: ... let's get started.

The first one comes from Leesburg, Virginia. And, Dr. Nachtigall, Sandy writes: She is "very confused and angry" -- and I think a lot of women out there can share that -- those feelings -- "about the recent report concerning hormone therapy. I have no breast cancer in my family, was taking the drug to ward off osteoporosis and heart problems. Now, I don't know what to do. I have never had hot flashes, but did have terrible mood swings before taking Prempro. If I stop taking that, will the mood swings return? The reason I am angry, why weren't more studies done on this before hormone drugs were put on the market? -- Dr. Nachtigall.

NACHTIGALL: You know, I think estrogen is the most studied drug we have ever had, so I think a lot of women are getting the wrong impression that it's never been studied before.

I published a study in 1979 of 10 years of comparing estrogen to a placebo. So it has been studied. This study....

KAGAN: So Prempro is an estrogen drug?

NACHTIGALL: Prempro is an estrogen combined with progestin. It's different, because it's estrogen and progestin every single day, which was really a new way of taking it in the last seven years. And it did go through studies and found to be very safe as far as safety goes.

So this new study was looking at long-term effects, and actually it had a lot of good news, that the short-term, under four years, had really no major risk. And none of the findings were really statistically significant. I think they were right to stop this study, because they saw a trend, and they thought the trend didn't look good, particularly for clotting. That was significant.

GUPTA: And you know...

NACHTIGALL: So for the individual woman who is asking this question, I think it depends on her. Would her mood swings return? Very likely. And she could probably go off the estrogen-progestin combination, the way she is taking it, take estrogen, maybe even a lower dose of estrogen, and take the progestin a different way or a different compound.

GUPTA: And you know, the thing, Dr. Nachtigall, that sort of strikes me, and the second question actually highlights that, is that doctors are confused about this just as much as patients.

"I started on Premarin after having had a hysterectomy and have taken it for five years for both heart and bones. I am 64. My heart doctors says to stop. My internist says no. What to do? And if I do stop -- gradual or cold turkey?"

Doctors are having a hard time agreeing on this, Dr. Nachtigall.

NACHTIGALL: Yes. Absolutely. I think the big thing is never stop cold turkey. There was no emergency. They just stopped the study, and they didn't want to supply study drugs. But they did say in a letter to the women on this study, go see your doctor in the next few months and get individual recommendations from your own physician, which is what I totally agree with.

If you are taking it for protection of bone, it will work. One of the good news that came out of this study was that it definitely prevented hip fractures, spinal fractures and other fractures.

Now, there are alternatives for bone. We're lucky. We have other things. They do -- they work differently. You know, we have bisphosphonate drugs, and we have raloxifene. We have other drugs, but they have different effects on the rest of your system.

So the estrogen-alone-arm with just Premarin was not stopped, and that's going to go on for another three years. And right now, they don't have any increased risks.

So the answer to a woman with a hysterectomy who is only on estrogen, if you are feeling well and you are doing well, there's no reason to go off it. Again, you might want to lower the dose. But you are not going on it for heart prevention, because that is one thing that came out, that you are not really going to prevent heart disease.

KAGAN: Let's try to get as many of these questions in in the limited that we have.

This one comes from Pat in Shoreview, Minnesota, who asks" "Could HRT be responsible for cancers, other than breast cancer? All we hear about is the link to breast cancer, but it would seem to me that it could be linked to other cancers as well or was breast cancer the only link that was looked at?"

NACHTIGALL: In this study, they looked at a few cancers, and the endometrial cancer, which is the lining of the uterus, that's what progestin does do well. It protects you from that kind of cancer. So the endometrial cancers were decreased. And really one of the few significant statistical findings was it actually decreased colon cancer, the second most common cancer in older women.

So, so far, it looks very good. And the risk of breast cancer was up only slightly, really much less than we really assumed.

GUPTA: And I know a lot of women do ask about the breast cancer link, no question.

You already mentioned maybe a little bit of the answer to this next question, which is really about bones again, osteoporosis.

"I am 48. I have diagnosed with osteoporosis. Should I stay on HRT for the sake of my bones?"

Sort of summarizing what you said before, Dr. Nachtigall. It sounds like there are some other good options out there, bisphosphonates, raloxifenes, other medications. Go to your doctors about that. Is that what you would recommend?

NACHTIGALL: Yes, that's what I would recommend. You can go on an alternate.

I must say for a 48-year-old woman, who must have had an early menopause if she is on for 10 years, she probably does well on estrogen. And you know, individually she should reconsider that. But there are alternatives for bone.

GUPTA: You know, it's also interesting, I think one of the things that people talk about are natural remedies and trying to use less medications.

This woman writes -- Dolly L. writes: "We all know that we should eat healthy, exercise, and above all, have a positive and happy attitude. A woman should never think that I'm just getting old. It's all in the mind."

What do you think about that, Dr. Nachtigall? Just in the mind?

NACHTIGALL: I wish it were true. You know, there was a great study done by Kaiser Permanente a few years ago, where they took healthy women who exercised, took calcium and ate right. And if they had the genetic predisposition for osteoporosis, they broke their bones.

So unfortunately, some women can do fine just "living healthy" -- quote. And some women can't. So again, you must individualize it. I think every woman deserves that.

KAGAN: Absolutely, and deserves to go talk to her doctor.

GUPTA: That's right.

KAGAN: We were lucky enough to have two with us today.

GUPTA: And you're living healthy.

KAGAN: I am living healthy, premenopausal; I want it on the record.

Dr. Nachtigall, thank you for coming by and answering our questions. I think it is especially appropriate to have a female OB- GYN with us to answer some of the questions that have been coming in. And, Dr. Gupta, thanks for being with us, too.

GUPTA: Thank you.

KAGAN: Very good.

TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com.