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Daily Dose: New HRT Warning Labels

Aired January 09, 2003 - 11:37   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: The government is trying to clear up some confusion over the risks of hormone replacement therapy. The Food and Drug Administration has announced a new warning and new labels for drugs used by millions of women in the United States. This new warning and the label for hormone replacement therapy are the result of a landmark study last year.
We're "Paging Dr. Gupta" on this one to talk about that. Our medical correspondent, Dr. Sanjay Gupta, is here along with Dr. Ira Horowitz. He is a professor and director of gynecologic oncology at Emory University School of Medicine.

Doctors, thanks for joining us.

DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Good morning. Thank you.

Lots of questions, lots of interest in this topic. We've been talking about it since August really.

Dr. Horowitz, a lot of patients come to you -- welcome, first of all -- a lot of patients come to you say, and that we're concerned about hormone replacement authority. We heard it was going to be great things, but it's not turning out to be that way. What can they do instead? What are you telling them? You see these patients:

DR. IRA HOROWITZ, EMORY UNIVERSITY: Well, there are lots of alternatives. One, I think the only role for the hormones would actually be to relieve some of the symptoms, and in those patients who are at high risk for osteoporosis. For alternatives, there are several remedies you can get over-the-counter such as black cohash, which about 30 percent of people respond to. There are also the selective serotonin and reup intake inhibitors, which can also decrease some of the symptoms. That would be the hot flashes and stuff. And then some of what we call Cerms (ph). And rolaxafin would be the one that's presently on the market in the United States.

KAGAN: One thing we're hearing about this new warning coming out today, if you're going to use hormone replacement therapy, use it for the shortest amount of time possible.

HOROWITZ: Well, the study actually showed that if you're on the hormones, which included estrogen and progesterone, for five years or longer, you had an increased risk of having breast cancer, heart disease, and blood clots. However, if you were on it for a shorter period of time, you didn't see that increased risk, and that was also estrogen and progesterone. The data right now is not complete with just estrogen as a single agent.

KAGAN: A lot of e-mail coming in for you, doctor, so let's get right to them. The first one is coming to us from Mike. He writes in, "Would you have your loved one take hormones? I recently discouraged my mom from taking them because of all the controversies."

What would you say at home Dr. Horowitz?

HOROWTIZ: That's tough. I would explain to my wife, as I would any of my patients, what the risks and what the benefits are. If it's for a short period of time, I would go ahead and encourage her to go ahead and use the estrogen, but if it's for a prolonged period of time, I would look for alternatives.

KAGAN: What is short?

HOROWTIZ: Well, the studies again showed more than five years of combination therapy. But short would be the shortest period of time we could go ahead and give you the medication to decrease your symptoms.

GUPTA: I think we've got a lot of questions on that very topic. Let's go to the next one here. "Does the very small dose of 0.25 milligrams of estrogen for hormone replacement therapy actually need the addition of progesterone to avoid the risk of uterine cancer."

Someone concerned about cancer and avoiding it. What do you tell them?

HOROWTIZ: Anytime you have a uterus, you really need to consider having progesterone. The incidence of uterine cancer plummeted in the United States and throughout the world when we added progesterone.

Unfortunately now, we think progesterone is a bad actor for the breast, but it's imperative that we go ahead and continue to use estrogen and progesterone combinations with the uterus.

KAGAN: You mentioned whether you have one or you don't. Here's a woman who said she had a complete hysterectomy back when she was 32. She didn't start on hormones until maybe 42. Linda wants to know, "Do I still run the risk of breast cancer? I feel I cannot do without the estrogen pills." What are her risks?

HOROWITZ: Well, first, you don't know how long she's really been on the estrogen. There have been other studies that have suggested that estrogen may cause breast cancer, and then another group of studies that shows they didn't cause breast cancer. Right now, with this particular study, the jury's out within the next few year.

So it's really difficult to answer that but if she can look at alternatives and she's not at high risk for osteoporosis, she should go ahead and do that.

KAGAN: One more?

GUPTA: Let's try and get one more in. this is a question that comes up a lot, "What is considered a safe maintenance-level dosage for a postmenopausal woman."

You may have already answered to that to some extent, but what do you tell your patients that are coming in asking that?

HOROWTIZ: Right now, we're looking for the lowest dose possible, and that's an individual thing. If you're a young woman and you've just had your ovaries removed, then you're going to need a higher dose. If you're older, and you've been through the menopause process and it's been a slow process and you've been on other medications, we can lower your dose.

KAGAN: Bottom line, talk to your doctor.

HOROWTIZ: Without a doubt.

GUPTA: One of the most interesting things in medicine, it's pitched as a panacea, going to fix heart disease, breast cancer, all these sorts of things, not seeing that. So interesting perspectives.

KAGAN: And I got say, as a woman, just so, so many questions out there, whether you have to face that question right now or whether it's for your mother or eventually in the future. I guess it will be changing and we'll be checking back with you.

Dr. Horowitz, thank you. Dr. Gupta, as always, thank you.

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







Aired January 9, 2003 - 11:37   ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DARYN KAGAN, CNN ANCHOR: The government is trying to clear up some confusion over the risks of hormone replacement therapy. The Food and Drug Administration has announced a new warning and new labels for drugs used by millions of women in the United States. This new warning and the label for hormone replacement therapy are the result of a landmark study last year.
We're "Paging Dr. Gupta" on this one to talk about that. Our medical correspondent, Dr. Sanjay Gupta, is here along with Dr. Ira Horowitz. He is a professor and director of gynecologic oncology at Emory University School of Medicine.

Doctors, thanks for joining us.

DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Good morning. Thank you.

Lots of questions, lots of interest in this topic. We've been talking about it since August really.

Dr. Horowitz, a lot of patients come to you -- welcome, first of all -- a lot of patients come to you say, and that we're concerned about hormone replacement authority. We heard it was going to be great things, but it's not turning out to be that way. What can they do instead? What are you telling them? You see these patients:

DR. IRA HOROWITZ, EMORY UNIVERSITY: Well, there are lots of alternatives. One, I think the only role for the hormones would actually be to relieve some of the symptoms, and in those patients who are at high risk for osteoporosis. For alternatives, there are several remedies you can get over-the-counter such as black cohash, which about 30 percent of people respond to. There are also the selective serotonin and reup intake inhibitors, which can also decrease some of the symptoms. That would be the hot flashes and stuff. And then some of what we call Cerms (ph). And rolaxafin would be the one that's presently on the market in the United States.

KAGAN: One thing we're hearing about this new warning coming out today, if you're going to use hormone replacement therapy, use it for the shortest amount of time possible.

HOROWITZ: Well, the study actually showed that if you're on the hormones, which included estrogen and progesterone, for five years or longer, you had an increased risk of having breast cancer, heart disease, and blood clots. However, if you were on it for a shorter period of time, you didn't see that increased risk, and that was also estrogen and progesterone. The data right now is not complete with just estrogen as a single agent.

KAGAN: A lot of e-mail coming in for you, doctor, so let's get right to them. The first one is coming to us from Mike. He writes in, "Would you have your loved one take hormones? I recently discouraged my mom from taking them because of all the controversies."

What would you say at home Dr. Horowitz?

HOROWTIZ: That's tough. I would explain to my wife, as I would any of my patients, what the risks and what the benefits are. If it's for a short period of time, I would go ahead and encourage her to go ahead and use the estrogen, but if it's for a prolonged period of time, I would look for alternatives.

KAGAN: What is short?

HOROWTIZ: Well, the studies again showed more than five years of combination therapy. But short would be the shortest period of time we could go ahead and give you the medication to decrease your symptoms.

GUPTA: I think we've got a lot of questions on that very topic. Let's go to the next one here. "Does the very small dose of 0.25 milligrams of estrogen for hormone replacement therapy actually need the addition of progesterone to avoid the risk of uterine cancer."

Someone concerned about cancer and avoiding it. What do you tell them?

HOROWTIZ: Anytime you have a uterus, you really need to consider having progesterone. The incidence of uterine cancer plummeted in the United States and throughout the world when we added progesterone.

Unfortunately now, we think progesterone is a bad actor for the breast, but it's imperative that we go ahead and continue to use estrogen and progesterone combinations with the uterus.

KAGAN: You mentioned whether you have one or you don't. Here's a woman who said she had a complete hysterectomy back when she was 32. She didn't start on hormones until maybe 42. Linda wants to know, "Do I still run the risk of breast cancer? I feel I cannot do without the estrogen pills." What are her risks?

HOROWITZ: Well, first, you don't know how long she's really been on the estrogen. There have been other studies that have suggested that estrogen may cause breast cancer, and then another group of studies that shows they didn't cause breast cancer. Right now, with this particular study, the jury's out within the next few year.

So it's really difficult to answer that but if she can look at alternatives and she's not at high risk for osteoporosis, she should go ahead and do that.

KAGAN: One more?

GUPTA: Let's try and get one more in. this is a question that comes up a lot, "What is considered a safe maintenance-level dosage for a postmenopausal woman."

You may have already answered to that to some extent, but what do you tell your patients that are coming in asking that?

HOROWTIZ: Right now, we're looking for the lowest dose possible, and that's an individual thing. If you're a young woman and you've just had your ovaries removed, then you're going to need a higher dose. If you're older, and you've been through the menopause process and it's been a slow process and you've been on other medications, we can lower your dose.

KAGAN: Bottom line, talk to your doctor.

HOROWTIZ: Without a doubt.

GUPTA: One of the most interesting things in medicine, it's pitched as a panacea, going to fix heart disease, breast cancer, all these sorts of things, not seeing that. So interesting perspectives.

KAGAN: And I got say, as a woman, just so, so many questions out there, whether you have to face that question right now or whether it's for your mother or eventually in the future. I guess it will be changing and we'll be checking back with you.

Dr. Horowitz, thank you. Dr. Gupta, as always, thank you.

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