On Thursday, the morning after she'd read the latest news that hormone replacement therapy could be linked to an increased risk for dementia, Gillian McBreen of Concord picked up her pill bottles and then set them down.
"I thought, no," said McBreen. "Not today. I don't know what I'll end up doing, but I'm not taking them today. The thought of losing one's mind is too frightening."
In light of a recent study that noted an increase in dementia in older women using a combination of estrogen and progestin, undoubtedly thousands of women across the country are staring at their pill bottles and wondering the same thing. Is hormone replacement therapy, once considered a godsend for middle-aged women going through menopause, doing more harm than good? Or are the risks being overstated?
Alice Stamm, founder of the hugely popular Web site www.power-surge.net, says this week's news came as no surprise to her. She has long condemned the use of synthetic hormones, favoring instead natural products made with soy and other vegetables.
Stamm, who created her Web site as a place where women could educate themselves and each other about menopause, believes pharmaceutical companies and doctors have preyed on women by producing and over-prescribing the drugs, pushing them as a cure for every symptom menopausal women have.
"It's all to shut us up," Stamm said in a telephone interview from her New York home. "Women going through menopause is not a pretty picture. Managed health care has made it so that doctors can only spend approximately 15 minutes with their patients. By the time a woman finishes reciting half of the menopausal symptoms she's experiencing, the 15 minutes are up."
The bulletin boards at power-surge.net seemed to take the news in stride, offering a sort of ho-hum, we knew it all along take on Wednesday news casting more doubt on the use of synthetic hormones.
But on other Web sites, women were asking questions and expressing equal parts fear and anger.
Of the near 1 billion women worldwide facing or undergoing menopause, about 15 percent have symptoms so severe as to be debilitating. Decades ago, pharmaceutical companies heralded hormone replacement therapy as a solution to many of their ills.
HRT -- a combination of estrogen and progestin -- would ease the night sweats and hot flashes, lessen the mood swings and relieve uncomfortable changes going on inside. As a bonus, HRT was thought to reduce the risk of breast cancer, heart disease and osteoporosis, and in some cases, delay the onslaught of dementia and other cognitive skills loss.
Millions of women signed on and prescriptions soared. Then, last summer, the National Institutes of Health dropped a bombshell, announcing it was ending a study of 16,600 postmenopausal women because preliminary results indicated an increased risk of breast cancer, heart attack and stroke.
In the intervening months, there has been some criticism of the study, but prescriptions for the most popular HRT drugs have dropped -- by as much as 40 percent for some brands -- and many women have switched to natural hormones found in soy products. Still, thousands remained on the medication, choosing to discount the study, willing to accept the risks, or unwilling or unable to give up the therapy.
Then the second bomb dropped earlier this week.
Researchers found the estrogen and progestin not only didn't improve mental acuity in women, but actually doubled their risk of developing Alzheimer's and other dementia diseases. Experts characterized the news as yet another nail in the coffin for synthetically produced hormones.
While this study also has found its critics -- most of the women in the study who developed dementia were older and might have suffered the condition even without the hormones -- the news has unsettled many.
McBreen, a working grandmother who considers age nothing but a number, says the report really frightened her. She had been taking HRT for about seven years. She started when she switched doctors and her new physician was shocked to learn McBreen wasn't already taking hormones.
The doctor, a woman, couldn't say enough about HRT, McBreen said, and told her she was risking a massive and potentially fatal coronary without the hormones. McBreen was going through menopause but considered her symptoms mild. Although her family has no history of heart disease or cancer, the hormones seemed to promise good health.
Last year, when the news came out about potential dangers, McBreen considered her options. She stopped the medications for a while, but when she began experiencing hot flashes and insomnia, she decided that for her, the risks were low and she resumed her daily regimen.
The thought, however, that hormones might cause her to have a series of small strokes that would cripple her mind, was too much.
"I'll talk with my doctor, but it really frightens me," McBreen said. "I just may let nature take its course."
It didn't take this week's news to convince Cindy Crausgrill of Clayton to stop her HRT. She quit last July when the first report came out. She had only started about three months before the study was released, but the news, coupled with the side-effects she was experiencing, made her stop the treatment immediately.
"I just thought this is not worth it," Crausgrill said. "If there was a possibility of these other things, then I saw no sense going on with it. When I saw the news (Wednesday), I was glad that I had stopped."
The decision hasn't been that cut and dried for many women. A number of women suffer greatly with menopause symptoms. There's no debate for them. In order to function, they need the hormones.
And some question whether the risk is all that great. The numbers from the study, translated to a larger population, mean that for every 10,000 women taking the combined hormone therapy, there would be an additional 23 cases of dementia per year.
"The overall individual risk to women is low, although there is reason for concern," said Sally A. Shumaker, the national principal investigator of the study and a professor of public health sciences at Wake Forest University Baptist Medical Center.
"Because of the potential harm and lack of benefit found," Shumaker said in a nationally issued statement, "we recommend that older postmenopausal women not take the combination hormone therapy to prevent dementia and we hope that doctors will incorporate what we've learned in their recommendations to women."
Doctors in the Bay Area and around the country struggle with questions. Many say they will do as they did last year and send letters out to their patients outlining the pros and cons, and offering to set up one-on-one discussions.
Nothing in medicine and human health is black and white, they say. It's very much a personal decision, and what's right for one person may not be for the other.