No More Hormone Replacement Therapy? What Now (NAPSA)—Foryears, my physician has been telling me to take hormones, that it’s good for me and that it will make me feel younger, even look younger. Now he’stelling me to stop. What do I do now? Sound familiar? For years we as physicians have believed that hormone replacement therapy (HRT) was good for you. The truth is that HRT still has a place for postmenopausal women, but in a more limited role. Current recommendations for HRT are for shortterm use in only three situations: * Relief of moderate to severe hot flashes and night sweats * Relief of moderate to severe symptomsof vaginal infections * Prevention of postmenopausal osteoporosis when nonestrogen therapies have been carefully considered If you stopped HRT or are thinking about going off HRT,it’s important to know that you may experience significant bone loss, about 3-5 percent bone loss per year, after discontinuing HRT. Bone loss could lead to osteoporosis, a serious disease affecting more than 10 million Americans, of which 80 percent are women. Another 30 million Americans have low bone mass, a precursor to osteoporosis. When left untreated, osteoporosis can weaken bones, which could lead to fractures. If you’ve stopped HRT therapy, are considering discontinuing @ HRT therapy, or if you think you may be at risk for osteoporosis, then you should consider seeing your physician to have a baseline bone density test. Risk factors for osteoporosis may include being postmenopausal, of Caucasian or Asian heritage, having a small/ thin frame, having a family history of osteoporosis, leading an inactive lifestyle, smoking, excessive use of alcohol, and having a diet low in calcium. The best way to test bone density is by a DXA scan,or low level X-ray, of your hip and spine. Your baseline score can determine if you need medication to protect your bones. Some women may only need calcium and exercise, others may require treatment with appropriate medications. There are five non-hormonal FDAapproved therapies for osteoporosis, Actonel, Evista, Fosamax, Miacalcin, and Forteo. Your doc- tor can explain the benefits and side effects of each to you. The Southwest Osteoporosis Council has developed the following recommendations for women who have stopped HRT: * Get a baseline bone density test, preferably a DXA scan to measure bone density of the hip and spine * Receive a follow-up bone health evaluation one to two years later to determine any changes in bone density or change in bone density as a response to new therapy * Consult with a physician knowledgeable about menopause and bone health * Understand the importance of calcium, vitamin D, and exercise in keeping bones healthy and strong. However, for many women, these alone are not enough to prevent osteoporosis. Stopping HRT is a decision that should be made in consultation with your doctor. If you stop taking HRT,don’t forget about your bones. It’s a lot easier to prevent osteoporosis thanit is to treat it. Peter Weiss, M.D., FA.C.O.G., Assistant Clinical Professor of Obstetrics and Gynecology, UCLA School of Medicine Submitted on behalf of the Southwest Osteoporosis Coalition, with contributions from Dr. Lee Vliet, Dr. Diane Schneider, Dr. Cheryl Lambing and Dr. Eugene Boling.
