HEALTHMenopause medicine: Custom-fit quandaryNo woman wants hot flashes. But fixing an annoying problem probably isn't worth risking a fatal one. Risk/benefit studies on HT leave physicians searching for individual solutions for individual patients.By Stephanie Stapleton, amednews staff. July 21, 2003. Single medical research studies rarely throw wrenches into everyday clinical practice. But that's exactly what happened last July. A Women's Health Initiative review panel ceased its estrogen plus progestin study because a statistically significant increase in breast cancer risk emerged. Almost overnight, the way doctors interacted with patients in managing menopause was altered. "The biggest thing about this study -- it impacted women's faith," said Audrey Curtis, MD, the director of women's health for Kaiser-Permanente Northwest in Portland, Ore. "There was a breakdown in the system." Doctors had been telling women that these drugs were good for them, and in many respects, they weren't. Combination hormone therapy, widely prescribed and viewed as a proverbial fountain of youth, was suddenly transformed into a perplexing set of risks and benefits. Physicians now must help women figure out how to manage sometimes debilitating symptoms while also confronting concerns about breast cancer, bone loss and even heart disease. Many agree that the experience has marked a sea change in menopause medicine -- a switch from a one-size-fits-all presumption to individualized therapy. "It's been really dramatic," Dr. Curtis said. In the months since the news broke, she said, the clear pattern among her patients is that there is no pattern. They are different ages and have different concerns, different family histories and different degrees of willingness to take risks. [...]Full text of American Medical News content is available to AMA members and paid subscribers.
Copyright 2003 American Medical Association. All rights reserved.
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