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Still on HRT after all these years of bad news

Sometime back in the mid-90s, when Nicole was still married to Tom and young families were flocking to buy SUVs, I asked my doctor what had become of the woman I had been until pieces of myself flew off in all directions like beads from a broken necklace. He nodded as I recounted the symptoms: sleepless nights, jangled nerves, shattered concentration. “I can’t go on like this,” I pleaded. “I’ve got a magazine to run.”

Not to worry, he had just the thing. A little blue pill every morning and a fat white one at bedtime, the size of a fake pearl. Estrace and prometrium,  which that day became the chemical buffers between me and the hormonal mayhem of midlife. But my initial relief at the return of serenity and reason has for years been interspersed with pangs of unease every time new research links HRT to the illness women fear most—breast cancer.

Yes, it’s true: I’ve been taking this stuff for years. About 14 years, I’d guess. Go ahead, call me crazy. While most authorities aren’t telling women to avoid HRT under any and all circumstances, they do advise us to avoid them if we can and, if we can’t, get off them at the earliest opportunity. So when am I quitting? Hmmm. We’ll see.

The latest alarm was sounded just this week with a study showing that five years on HRT will double a woman’s breast cancer risk. We’re talking a few extra cases of breast cancer per thousand women on hormones—hardly an onslaught, but worrisome enough that I always pause when someone in a white coat looks up from her form and asks me which medications I’m taking. “HRT” is no longer a routine answer to this most routine of questions. My friends glaze over in polite dismay at the very thought of 14 years on hormones.

I was the first woman in my circle to fill a prescription for HRT. As word got around, friends and colleagues plagued by hot flashes would turn to me for reassurance that they too could soon make a sales pitch or a boardroom presentation without whipping off their jackets to reveal sweat-stained blouses. I heard about an “HRT intervention,” in which a cranky, exhausted woman was gently but firmly advised that the time had come to seek help.

That changed overnight in 2002, when news broke that a controlled study of HRT had been abruptly cut off because of compelling evidence that the treatment did more harm than good.  was more harmful than helpful. I’d no sooner arrived at my office than a friend rang, bristling with alarm, to say that she was giving up hormones—as I would, if I valued my health. “The time isn’t right,” I said. “I’ll deal with that when I don’t have a magazine to run.” Meanwhile women were deciding by the thousand that the time had already arrived. A year later, breast cancer rates had plunged.

It’s been four years now since I had a magazine to run. Yet here I am, still hooked on HRT. A few months ago, I arrived in London to find—horrors!—I’d forgotten the little blue pills and their big white companions. If I couldn’t replace them pronto, I’d spend our vacation shouting at my husband and mopping up sweat. Surely a friendly pharmacist would issue an emergency prescription, or at least accept a fax from my doctor. Not allowed in Britain, I was told. Result: half a day spent finding a doctor, who solved my problem for 75 pounds. My insurer has declined to cover any portion of this.

If ever there was a time to feel like a chump for taking HRT, that time is surely now. The latest study, which underscores earlier findings, immediately followed a bombshell in the New York Times, which reported that Wyeth, manufacturer of the hormone preparation Prempro, had paid doctors to put their names on articles favourable to the drug. Wyeth has denied the charges and I’m never taken Prempro, but let’s just say that it doesn’t look good.

I have tried—twice—to ditch my daily pills. No one advises quitting hormones cold turkey, so both times I followed a regimen: cut the blue estrogen pills in half, then stagger the precious chips at ever-longer intervals until, as one friend has assured me, “you realize you’re taking so little of the stuff, you don’t bother taking any more.” Both times I became a frazzled, sleep-deprived wraith—and gratefully reverted to the full-bore dose. As you know if you’ve been following these posts, I have enough trouble sleeping with HRT. I give myself full marks for getting off the maximum dose of a certain sleeping medication. And now I’m supposed to settle for the jagged sleep of the aging? Not a chance.

Maybe I was lying awake when the truth settled into my reluctant brain. Or maybe I was padding about in the lonely hours, looking for a book to lull me into a semblance of sleep. It’s hard to say just when I realized, in the core of my Pilates-toned being, that no matter what I do to stay healthy, I’m going to die of something. This year cancer carried off two of my friends, women who’d been taking good care of themselves and were not, to my knowledge, on HRT. As I write this, another friend is grappling with a newly diagnosed cancer. A colleague, having beaten one cancer, is steeling herself to do battle with another. I have never felt so conscious of the boundary between health and galloping disease.

I’d like to be the first person to live forever, with all my marbles. Since it appears that I won’t get my wish, I’ll settle for the next best thing—living as well as I can in the time I can get. For the time being, sleep is part of that picture. If I pay with fewer years on this earth, so be it.

Click here and here to read previous posts on insomnia.

Posted by Rona

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