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Re: HRT for treatment of osteoporosisFrom: William D. McIntosh, MD (anonymous@obgyn.net)Wed, 29 Sep 1999 09:56:08 -0500 (CDT)
At Tue, 28 Sep 1999, Mamaw wrote: > >I recently took my mother (age 79) for a checkup, not GYN. She has had >spurs and arthritis in her back for many years and is in a wheelchair >most of the time. She can walk for a few minutes but is in constant >pain if she has to stand still. The physicians assistant had her come >in to be checked for osteoporosis. Of course with all the other >ailments, including diabetes, neuropathy, hypertension, etc., they >suggested giving her hormones to aid in preventing any further bone >loss. She took hormones for a few years during/after menopause, but her >doctor at that time took her off of them due to bleeding or some reason. >That's probably been 20 years ago. To my knowledge she has not had a >pap smear during the last 10 - 15 years. Her only complaint has been >dryness and itching, no bleeding or pain. I'm sure her doctor should >have been doing pap smears during this time. However, my concern is, >should she start taking HRT after all these years and would it be of any >help at this stage of her life? If HRT would have helped, where was her >doctor before her back got so bad? He's a wonderful person and she has >all the confidence in the world in him. I want to see her feeling >better and get all the help she can, but I can't help but think, too >little, too late. Any advice you can give me would be appreciated. This is a difficult, and all too common situation. We don't know how much help replacement estrogen will be in women your mother's age, and we are certain that there will be only minimal bone replacement. About the best you can hope for is stabilization of the bone loss. There are other agents that might help with bone replacement. Gynecologic care in the elderly is an ongoing problem. Many women stop seeing their GYN after menopause, and their internists or FPs may or may not be comfortable doing routine pelvic exams. For that matter, many insurances, most expecially Medicare, will only pay for routine exams every 3 years. With so many other, seemingly more urgent health problems, asymptomatic GYN problems are all to easy to overlook. Finally, there is tremendous resistance to the use of HRT in the United States. Its benefits are incontrovertable, its impact on public health in line with routine immunizations and clean public water supplies, and yet I can go to the bookstore in the mall and pick up a dozen books that argue that HRT is everything from a male plot to subordinate women all the way to a poison that will give you breast cancer if you even look at the package. Only 15-20% of the women in the United States that would benefit from HRT actually get it. HRT has become dramatically easier to use, and the evidence of its effectiveness overwhelming, but only in the last 10 years or so. Remember, your mother went through menopause about 25 years ago probably. At that time, HRT was given only for hot flushes and vaginal atrophy. Its other benefits were unrecognized, or purely theoretical. If there is enormous resistance to HRT now, when the benefits are clear to anyone with an open mind, imagine what it must have been 20 years ago, both among patients and physicians.
-- William D. McIntosh, MD, FACOG Clarksville, TN
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