When her hormones got out of balance, Arleen Harms knew the risks of going on hormone therapy to get her body righted again, particularly with a strong family history of breast cancer.
"I had to weigh the difference," she said, but the short-term therapy helped. Now, there is more to add to the risk side of the scale.
In the latest blow to post-menopausal hormone therapy, a large national study found that women on the therapy were twice as likely as those on a placebo to get dementia.
In an article published today in the Journal of the American Medical Association, the Women's Health Initiative Memory Study reported that 61 of the 4,500 women in the study had developed dementia - 40 in the combination estrogen-progestin hormone therapy group and 21 in the control group. Previous reports from a larger group in the study showed that the therapy increased the risk for breast cancer, stroke and cardiovascular disease.
There was some evidence, although it was not conclusive, that estrogen might be beneficial to the brain, because there had been evidence that estrogen might aid cardiovascular health, said article co-author Susan Hendrix.
"It's scary that you have women who are taking a drug to try to prevent a disease that actually causes the disease," said Dr. Hendrix, a researcher at Wayne State University in Detroit.
As with the previous reports, the dementia finding challenges some previously established benefits of estrogen to memory, said Richard White, a hormone researcher and associate professor of pharmacology and toxicology at the Medical College of Georgia.
Previous studies had noted estrogen receptors in critical areas of the brain, such as the hippocampus, that were thought to be involved with memory, Dr. White said, and some studies had shown benefit with Alzheimer's disease and dementia.
"It had been considered to at the very least to delay the onset or possibly to prevent it," Dr. White said.
He had found in a pig study that progesterone also lowered blood pressure, although by a different mechanism than estrogen. More research will be needed to find out whether progesterone, or the form used in the study, is blocking the beneficial effects of the estrogen. It will also be crucial to see the results of the estrogen-only arm of the study, now scheduled to conclude in 2005, he said.
Some hormone advocates say the problem is in the kind of hormones the drug contained.
"My problem with both those products is they both contain substances that never occur in a women's body unless they are a horse," said compounding pharmacist Eric Holgate of the Custom Prescription Shoppe in Augusta.
Premarin, part of the drug, is derived from pregnant mare urine. Different estrogens and progesterones do have a beneficial effect, he said.
Even if they are worried, some women find it too difficult to stay off the hormones when symptoms such as hot flashes and night sweats return with a vengeance, said Jennie Pill, a physician assistant at Medical College of Georgia Hospital and Clinics. About 75 percent of her patients who quit eventually returned, she said.
She should know - she has taken it herself for five years or so because of severe symptoms.
"I'll tell you this: If I didn't take hormones, you wouldn't even want to talk to me," she said jokingly. That there has been a slight decrease in colon cancer is of more interest; her mother died of colon cancer at age 42. She is 43.
There should be more research on better ways to wean women off the hormones - the study researchers were caught by surprise when they had to end the study early last year because of some cases of breast cancer and heart disease, Dr. Hendrix said. There need to be better alternatives, too, she said.
"There aren't a lot of good options, but there are options," she said.
At age 41, Ms. Harms hopes that she will have many years before she will have to face menopause. Science, she hopes, will have come up with more solutions by then.
"Do more research," she said. "Please."
Reach Tom Corwin at (706) 823-3213 or firstname.lastname@example.org.