Click on BROWN LINKS to navigate
THE ONGOING
ESTROGEN CONTROVERSY
Last Updated:
During my 30 years of medical practice I have seen the pendulum of the estrogen replacement controversy swing back and forth several times.
Recently there has been mounting evidence that estrogen, if we even use it at all, should be given only for 2-3 years to ease the hot flashes and mood swings during menopause, not for the rest of a woman's life.
When I was in medical school we were taught that most women ought to be on estrogen supplementation forever after menopause to reduce their risk of osteoporosis, reduce the risk of heart attack, preserve the function of vaginal tissues for lovemaking, and improve a number of other female maladies of aging as well.
In the late 1970's, driven largely by the women's movement, ladies began asking their doctors (mostly male in those days) to justify why they were routinely prescribing these hormones. The medical establishment had to admit that there was not enough rock-solid research evidence to support the hoped-for benefits; so many doctors began recommending that women take estrogen for only a few years during menopause to reduce their hot flashes. At the same time, several long-term studies were begun that were intended to track the health of large numbers of women taking estrogen over many years.
After years of exhaustive studies, the available evidence seemed to support most of the long-held beliefs about the benefits of estrogen; so during the late 1980's and 1990's most doctors were recommending that ladies continue HRT (hormone replacement therapy) indefinitely after menopause, if for no other reason than to reduce their risk of developing osteoporosis (brittle bones) in later years.
Then in July 2002 the National Heart, Lung and Blood Institute, a division of the National Institutes of Health (NIH), released the results of their important long-term study which concluded that for every 10,000 women taking both Premarin and Provera (or the combination drug Prempro) there could be, every year:
- 7 additional heart attacks
- 18 more blood clots
- 8 more strokes
- 8 more new cases of breast cancer
In the same month the National Cancer Institute (NCI) published their finding that women taking estrogen are also more likely to develop ovarian cancer. The more years they take estrogen, the more their risk increases (from a minimal increase within the first four years on estrogen to an 80% increase in risk after 10-19 years on the medication).
In the Spring of 2003 the New England Journal of Medicine reported the results of the Women's Health Initiative (WHI), a study conducted on 16,000 women ages 50-79 to determine if HRT had any effect on a variety of postmenopausal "quality of life" issues such as depression, cognitive functioning (thinking), sleep, and sexual satisfaction. There was no significant difference in these particular "quality of life" issues between the ladies taking HRT and those taking only a placebo.
On balance, it must be emphasized that most of these women were far past their menopause and were no longer being tormented by the hot flashes, night sweats, or the major mood swings of early menopause, symptoms that will almost always improve with estrogen.
In June of 2003 the Journal of the American Medical Association published a study which suggested that for every 10,000 women who take the combination drug Prempro for an extended period of time there were 23 more women who developed dementia than would normally be expected in their age group, another negative effect presumably attributable to hormone replacement therapy.
So what now for you? Should you stop your estrogen? Probably.
Once you are no longer having hot flashes there seems to be no valid reason to continue estrogen therapy.
At this time I will not withhold estrogen from women who are convinced they are experiencing definite quality-of-life benefits and wish to continue taking it despite the known (albeit statistically minor) risks, but I do believe we ought to begin discussing better long-term alternatives once a woman is several years into her menopause and no longer having hot flashes, etc.
Please schedule an office visit; so we can discuss the growing list of medicines available to minimize menopausal symptoms while at the same time reducing your risk of osteoporosis, heart disease, and cancers of the breast, uterus, and ovaries.
MANAGING HOT FLASHES
Half of all women going through menopause report feeling irritable or depressed. One third will experience vaginal dryness, decreased libido (sexual interest), or painful intercourse. 85% will experience hot flashes, but only half of those women find them disturbing. 50% of women experience hot flashes for five years while more than 20% have hot flashes for less than a year.