Women arrive at Dr. Wendy Wolfman's menopause clinic carrying shopping bags filled with herbal remedies. Most of it, she said, "is just completely a waste of money."

Some women are willing to try anything to deal with debilitating hot flashes, mood swings and other menopausal symptoms, Wolfman said.

Anything but hormones.

"They're afraid to take hormones because the publicity is they're going to get (breast) cancer," said the director of the menopause unit at Mount Sinai Hospital in Toronto.

Now, the Society of Obstetricians and Gynaecologists of Canada is urging Canadian women to rethink their aversion to hormone therapy. The doctors' group says that women have been needlessly frightened off a "safe and effective therapy" by reports implicating hormones in breast cancer.

In an article titled "Misinformation. Misinterpretation. Missed opportunity." posted on the gynecologists' group's website, executive vice-president Dr. Andre Lalonde says the organization has supported the breast-cancer cause "for years."

"Unfortunately, it is becoming increasingly clear that effective advocacy programs, combined with a media focus on breast cancer, has distorted women's perception of their true risk for this disease," — to the point that "many distressed symptomatic menopausal women are being denied, or are choosing to avoid, a safe and effective therapy for which the overall benefits exceed the risk," Lalonde said.

The message has some critics bristling.

"To call this increase in risk of breast cancer (with hormone therapy) a slightly increased risk, it seems to be a message to essentially say 'Don't worry about it.' I was shocked by it," said Dr. Barbara Mintzes, an assistant professor in the department of anesthesiology, pharmacology and therapeutics at the University of British Columbia.

Prescriptions for hormones plummeted in the wake of the Women's Health Initiative Trial, or WHI, one of the largest studies ever conducted in the U.S. The trial was prematurely halted in 2002 after researchers found an increased risk of stroke, heart attack and invasive breast cancer in women using an estrogen plus progestin formulation.

But Lalonde said the level of increased risk was small, with eight additional cases of breast cancer detected among 10,000 women using combination hormone therapy.

"The most recent report from the WHI states that breast cancer accounted for 2.6 deaths/10,000 combined hormone users and 1.3 of 10,000 women assigned to placebo," Lalonde writes. "The actual difference was 1.3 additional deaths per 10,000 women."

He said the reports are heightening fears of breast cancer and confusion around a woman's individual risk.

In a recent TV clip to promote breast cancer awareness, CSI star Marg Helgenberger says, "You know what's a real crime? One in eight women will be diagnosed with breast cancer this year."

Lalonde said the "1 in 8" figure has been so misused "that people forget that it represents a cumulative lifetime risk to age 85", meaning that it applies to a woman who lives to age 85 and does not die of other diseases first.

The increased risks for breast cancer in users of combination hormone therapy is about the same risk women accept when they drink alcohol, don't exercise regularly or gain weight after menopause, Lalonde said.

But women and their doctors are abandoning hormones for "untested and largely ineffective" alternative therapies that have been shown to be little better than placebos.

Between 2002 and 2003, the number of hormone-replacement-therapy prescriptions filled in Canada fell from 11.6 million, to 9.5 million. In 2009, prescriptions for hormones totalled 4.8 million.

Many women are still using hormones. But more are being prescribed Prozac-like drugs instead for hot flashes and other menopausal symptoms once treated with hormone therapy.

Nearly 24 million prescriptions for SSRIs — selective serotonin reuptake inhibitors — and similar antidepressants were dispensed by Canadian drug stores in 2009, according to prescription drug research firm IMS Brogan; it's estimated that about 72,000 of those prescriptions were written for menopause.

SSRIs may reduce the effects of the breast cancer drug Tamoxifen. "So we may have traded one problem for another," Wolfman said.

Other studies have found an increase in bone fractures in women since 2002.

"No one is trying to talk women into hormones, only to emphasize that when menopausal symptoms are distressing that hormone therapy is a safe option," said Dr. Robert Reid, past-president of the SOGC and chair of the division of reproductive endocrinology and infertility at Queen's University.

"The media has tended to focus on hormone therapy as the bad guy, and the public is terrified to death of breast cancer, so the two get linked together, and now women are afraid to use a therapy that's very effective."

He said breast cancer advocacy groups "have been a little loose" with the statistics.

"If you have 1,000 women age 40, over the next 10 years, two will die from breast cancer, and 21 will die from something else," Reid said. In the decade between age 50 and 59, five women out of 1,000 will die of breast cancer, and 55 will die from other causes.

"In those younger ages, it could be leukemia, car accidents, or things like that, but as you get older it starts to be cardiovascular disease. Suddenly, you see cardiovascular disease totally outstrips breast cancer," Reid said.

The disparity grows as women age: After age 70, nine women out of 1,000 will die over the next 10 years from breast cancer versus 309 deaths from other causes.

"The reality for most women is that they're going to die from cardiovascular disease," Reid said.

But women overestimate their breast-cancer risk while underestimating their risk of heart attack and stroke.

"So women don't get their blood pressure checked, they don't take antihypertensive medication, they're not concerned about their cholesterol, and they don't exercise in menopause. But they're terrified about anything they hear linked to the possibility of breast cancer, because they think it's going to enhance that already high risk they think they have."

Reid said hormone therapy "has become an easy target."

This fall, Canadian researchers reported that the incidence of invasive breast cancer in Canada dropped by 10 per cent among women aged 50 to 69 from 2002 to 2004 — the same time record numbers of women stopped taking hormones.

Reid said the absolute benefit of stopping hormones was 0.28 fewer breast cancers per 1,000 women — about one less breast cancer case per 4,000 women.

"One third of women with breast cancer die, typically, so that's one less death per 12,000 women. The question is, do you deny 12,000 women improved quality of life and control of hot flashes for one less breast cancer death?"

A study published last week reported that women who take estrogen plus progestin have an increased risk of dying from breast cancer.

Reid said the absolute risk of death from breast cancer was 2.6 deaths per 10,000 women using combined hormones, versus 1.3 deaths per 10,000 women who didn't use hormones — an absolute increase of one additional death per 10,000 women.

Mintzes said a halving of deaths "is still rather impressive."

Breast cancer "is one of the more common cancers that women die of, or are diagnosed with," she said. "If we can actually prevent extra cases of cancer, that's wonderful."

"(Hot flashes) are not a life-threatening event in any woman," Mintzes said. "There is a range of symptoms, from very mild and minor to a very small proportion of women who find more severe effects on quality of life."

"It's a personal decision, obviously, whether to take hormone therapy or not," she said, but added that the Society of Obstetricians and Gynaecologists "seems to be highly supportive (of hormones) as a first-choice therapy."

Wolfman said that for women aged 50 to 59 taking estrogen alone, the Women's Health Initiative Trial "showed no significant increased risks in anything, with 30 per cent less mortality."

In Canada, record numbers of women are entering menopause, as the largest demographic from the "baby boomer" generation turns 50.

"I have women who the quality of their life is terrible," said Wolfman, whose clinic has a nine-month waiting list. "They're having maybe 15 flashes a day, they can't sleep, they can't work, and this is a time when a lot of women may be at the peak of their careers.

"No one says to them, 'If you take (hormones) for a few years there is very little risk. If anything you might derive some health benefit, certainly for your bones.'

"Over the long term there is a small increased risk of breast cancer, and that has to be a decision a woman has to make in conjunction with her doctor about whether the risk-benefit ratio is right for her."

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