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New menopause website stokes debate over HRT Add to ...

Experts predict a record number of Canadian women will reach or near the onset of menopause this year, and some say this has created a pressing need to educate women about the challenges that can be associated with the transition.

To that end, the Society of Obstetricians and Gynaecologists of Canada have led the development of a new 14-member coalition and the creation of a website ( menopauseandu.ca), unveiled yesterday, to provide a single place women can go to seek answers to questions about menopause.

When they get to the site, women will see a laundry list of symptoms that can be linked to perimenopause, or the period leading up to menopause, a quiz to help them determine if they're in menopause, and a link to several videos on topics relating to women's health.

But also peppered throughout the educational site are references to hormone therapy and how it's safe and effective for women when used for a "short-term" period, or no more than five years.

It's the kind of straightforward advice many women, confused over reports of links between hormone therapy and cancer, may welcome.

But it's also misleading, say women's health experts who have concerns about potentially harmful consequences of hormone therapy and the ties between drug companies who make the treatments and doctors who endorse them.

Hormone therapy has been one of the most hotly debated controversies in women's health since the 2002 publication of a study that showed women taking estrogen and progestin together had higher rates of breast cancer and heart disease, while those who took estrogen on its own experienced higher risk of stroke. That led to a marked drop in the number of women taking hormone therapy - a drop the SOGC said was too severe.

Now, the organization is trying to repair the image of hormone therapy by saying any increased cancer risk is slight as long as women limit their time on treatment to five years. The group issued new guidelines earlier this year endorsing the short-term safety of hormone therapy.

On its new site, the group has a section that debunks major safety concerns over hormone therapy, saying the risks are "about the same as" factors such as the late onset of menopause, excessive alcohol consumption or sedentary lifestyle.

"We tend to underestimate the importance of these factors, diet, exercise and alcohol consumption, and we generally focus on things that are outside of us, air pollution or medication," said Jennifer Blake, chief of women's health at Sunnybrook Health Sciences Centre in Toronto, as well as a member of the SOGC and its new coalition.

But this sends the wrong message, said Barbara Mintzes, a professor in the department of anesthesiology, pharmacology and therapeutics at the University of British Columbia in Vancouver. Most women don't experience the type of severe symptoms that warrant medical intervention, she said. Even if the risks are slight, they exist, which means women and their doctors should think long and hard about whether medication is needed, she said.

Prof. Mintzes pointed out that five of the six authors of the updated SOGC guidelines endorsing hormone therapy - including Dr. Blake - disclosed conflicts of interest as paid speakers or consultants for a range of drug companies, including those that make hormone therapy treatments.

The bottom line, according to one women's health expert, is that drug treatment should only be considered for a handful of women. Jerilynn Prior, a professor of endocrinology and metabolism and director of the Centre for Menstrual Cycle and Ovulation Research at the University of British Columbia, also argues that women who require treatment should receive only progesterone, not estrogen, to treat symptoms. Estrogen levels in perimenopausal women are typically high, so it doesn't make sense to treat them with that hormone, a point she argues in her new book, The Estrogen Errors: Why Progesterone Is Better for Women's Health.

Although the SOGC endorses the safety of hormone therapy, Dr. Blake said the new coalition and site are designed to stimulate conversation as new research emerges.

"In no way do way we want to suppress controversy or get ourselves corralled into a single point of view," Dr. Blake said.

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