A flash of hope for hormones

For women who have struggled with the symptoms of menopause but are fearful of taking risky hormone pills, there is at last a bit of hope.

Hormone skin patches and gels, it seems, are far less likely than pills to cause dangerous blood clots. At least that was the finding from a recently published French study.

Patches and gels are already known to be effective for relieving the hot flashes and sleep-interrupting night sweats that plague many women. No one knows whether they will prove safer than pills in terms of breast cancer, heart attack or stroke risk. A large study currently under way may answer that.

But if they do, it may soften some of the backlash against hormones since a landmark study in 2002 frightened many women away from their 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 proof yet that this may be true, said Dr. JoAnn Manson, chief of preventive medicine at Harvard-affiliated Brigham and Women's Hospital in Boston. She has no financial ties to hormone drugmakers 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.

Millions of women abandoned hormone pills after the Women's Health Initiative study reported in 2002 higher rates of stroke among those taking estrogen, and of stroke and breast cancer with estrogen-progestin use.

The study tested Wyeth's Prempro and Premarin, which contain synthetic estrogens made from the urine of pregnant horses. Some people believe 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 to 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 UT Southwestern Medical Center.