- The Washington Times - Sunday, February 25, 2007


Women who have struggled with the symptoms of menopause but are fearful of taking risky hormone pills at last get a bit of good news.

A recently published French study suggests that hormone skin patches and gels seem to be far less likely than hormone pills to cause dangerous blood clots.

Patches and gels are known to be effective for relieving the hot flashes and sleep-interrupting night sweats that plague many women. It is not known whether they will prove safer than pills in terms of breast cancer, heart attack or stroke risk. A large study under way may answer that.

But if they do, it may soften some of the backlash against taking hormones since a landmark study in the 2002 Women’s Health Initiative reported higher rates of stroke among those taking estrogen and of stroke and breast cancer with estrogen-progestin use. Critics of that study have long contended that it is the type of estrogen or progestin, the dosage and the method of taking the hormones that may affect the health risks.

The French study, while not the final word, is the strongest evidence that those arguments may be true, said Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women’s Hospital in Boston. She has no financial ties to hormone drug makers and just published a book giving women advice on hormone use.

Evidence is mounting that the method of taking a drug and possibly the dose are important factors, she wrote in an editorial accompanying the study in the journal Circulation.

The study tested Wyeth’s Prempro and Premarin, which contain synthetic estrogen made from the urine of pregnant horses. Some people think that estrogens from plant sources are closer to what the human body naturally produces and may be safer. The plant forms are in many competitors’ pills and also in patches, creams and gels.

The French researchers compared 271 women ages 45 to 70 who suffered blood clots with 610 similar women without clots. Women taking various hormone pills were more than four times more likely to suffer clots than women not taking hormones or receiving them through patches, gels or creams. The study was paid for by the French government and partly by hormone drug and patch makers.

Why the difference in risk?

“Part of the reason we think oral estrogens do cause clots is that they pass through the liver and can cause some clotting factors to be produced,” said Dr. Karen Bradshaw, director of women’s health and an endocrinology specialist at the University of Texas Southwestern Medical Center.

Hormones through skin patches are directly absorbed into the bloodstream and therefore can be given in far lower doses, she explained.

Before the Women’s Health study, Prempro and Premarin accounted for half of the hormones Dr. Bradshaw prescribed. Now they account for about one-fourth, and much of that is the lower dose of Prempro that Wyeth began selling in 2003.

A Wyeth physician, Dr. Eileen Helzner, noted that the French study did not randomly assign some women to patches and some to pills — the most rigorous scientific test. At least two previous, smaller studies reached differing conclusions on the clot risk, and more research is needed before definitive conclusions can be made, she said.

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