Donna G. Hurlock, M.D., P.C.  
     
     
I first met Dr. Jacques Rossouw on July 31st, 2001 when we both appeared on the Diane Rheme Show on National Public Radio to discuss the HERS study. You may remember this was the study which was interpreted by Dr. Rossouw and others (inaccurately) to show that estrogen does not help the heart. What the study actually did show was that Prempro does not reverse well established heart disease in 67 year old women who had never before taken HRT and then started it after they had established heart disease. It did not at all test the use of pure estrogen in 50 year old women at the onset of menopause. Nevertheless, based on that one study, rumors have been flying for about a year questioning the cardiovascular benefits of HRT for menopausal women. At that time one year ago, Dr. Rossouw stated that he would not give a friend estrogen even to protect her bones. He clearly already had made up his mind that estrogen was a dangerous and evil hormone that should be avoided entirely. And the scary part is that he was and still is the acting director of the Women's Health Initiative run by NIH. Now he has ended the part of that study that was looking at Prempro's effects on women, claiming that Prempro is dangerous. Here we go again.
Let me first address each of the points. First, it's stated that stroke was increased by 41% and that heart disease was increased by 29% in the study subjects compared to the placebo group. First, you should know that we're talking about a baseline incidence of about 2 in 10,000 for clotting episodes and now, with 41% increase, we may have a wopping 3 in 10,000. Guess what? 41 % of close to nothing is still close to nothing. Further, the study group in this study was also not made up of 50 year old women at the onset of menopause. Rather, the average age was 63 and I've heard that 15 percent of those entered with existing heart disease. Similar to the HERS population. As far as increased heart disease, how could a small amount of estrogen and progesterone cause such rampant heart disease in these women when much higher amounts such as we see in pregnancy and birth conrtol pill use does not cause those problems? When is the last time you saw a pregnant women clutch her chest and keel over with a heart attack? It just doesn't happen! Furthermore, the papers neglected to mention that THE DEATH RATE IN THE PREMPRO GROUP WAS ACTUALLY LOWER THAN IN THE PRLCABO GROUP. But yet it was the Prempro arm of the study that was discontinued. Why do women generally not get heart disease until they lose their ovarian function? Why do women who have their ovaries removed prematurely have much increased rates of heart disease that can be reversed by replacing the missing estrogen? What Dr. Rossouw is claiming just doesn't make sense. Yes, we know that these hormones, particularly progesterone, tend to increase clotting, but unless someone already has significantly diseased vessels or an underlying clotting disorder, the increased risk is extremely small. Of the 8,000 to 10,000 women I have treated over many years with estrogen, I know of only 3 clotting events, which is consistent with the data. None of those women died either.
On to breast cancer. They're claiming that Prempro has increased breast cancer by 24%. How could that be when they stopped the study after 5 years? It's well accepted that breast cancer takes about 8 to 10 years to grow large enough to be detacted by standard techniques. So these breast cancers that have been detected so far in this study were all there before the study even started! Yes perhaps Prempro acted as a detection aid, so a few more cancers were detected in that group, but that doesn't translate into causing the cancers or even haing an increased death rate from those cancers. Infact, in all ten studies that have looked at death rates from breast cancer, ALL of the studies have shown that THE WOMEN WHO HAVE EVER USED ESTROGEN REPLACEMENT CONSISTENTLY HAVE LESS DEATH FROM BREAST CANCER THAN THOSE WOMEN WHO HAVE NEVER TAKEN ESTROGEN. Ok Dr. Rossouw, how do you explain that?
Finally, I don't believe that Mother Nature could have screwed up so badly to have given us a hormone that is absolutely necessary for birth and life, even for Dr Rossouw's, and then it somehow transforms into a carcinogen, but only in small doses, since we know that birth control pill use does not cause increased breast cancer deaths. Mother nature is not that stupid. Tho perhaps she did slip up a bit when she made testosterone.
Anyway, if you still want to stop your HRT, you are free to do so. And if you want to discuss this further, please call Angie for an appointment. If you stop HRT and find that your health starts to deteriorate, I suggest you call Dr. Rossouw at home to discuss it. Particularly when you wake up with one of those lovely natural night sweats. Gotta go now and take my birth control pill. Hope this helps.