Aftermath of HRT study: Patient-by-patient re-evaluation

Physicians work to address patient fears and needs while reconsidering how they use hormone replacement therapy.

By Victoria Stagg Elliott, AMNews staff. Oct. 21, 2002.

The patient had mild symptoms of menopause -- some minor hot flashes and mood swings -- but nothing that was really disrupting her life. So Carol J. Grabowski, MD, an obstetrician-gynecologist based in Long Beach, Calif., recommended she try black cohosh, an herb widely believed to alleviate some menopause-related symptoms.

If the patient had seen Dr. Grabowski with the same complaints before July 9 -- the date that an arm of the Women's Health Initiative studying hormone replacement therapy was halted because of increased risks of breast cancer and cardiovascular disease -- she would have prescribed HRT.

But things are different now. July 9 has become the day that changed the perspective of many physicians toward HRT. As the dust settles, doctors are revisiting reasons for prescribing the therapy and carefully discussing risks and benefits with patients.

"The study took out my No. 1 reason for prescribing it," said Dr. Grabowski. "I thought I was preventing heart disease. Now, the reasons I have left are menopause symptoms and osteoporosis. If they're not that symptomatic, I tell them to try something else first."

In other words, the cost-benefit analysis is different.

"Estrogen is still good, but the context in which it is prescribed has changed," said obstetrician-gynecologist Mona Alqulali, MD, PhD, medical director of Women's Health Services in Clinton, Iowa.

Since those first days, and even weeks, when physicians' phones rang off the hook with calls from scared patients wondering what to do next, caution seems to be the rule. [...]