CONTROVERSIES IN HORMONE THERAPY

Hormone Replacement Therapy in the post menopausal patient has become a hotly

debated and somewhat confusing issue today. It was previously felt that administering

estrogen and progesterone to a woman after menopause was beneficial not only for

symptoms of hot flashes, vaginal and skin dryness, mood swings, insomnia, depression as

well as forgetfulness that is sometimes seen in that age group, but also for some

protection against coronary artery disease, dementia, and osteoporosis. Use of hormone

replacement therapy with estrogen and progesterone, or with estrogen alone, if the

woman had undergone a hysterectomy, was actually encouraged for extended periods of

time.

A study called the Women’s Health Initiative which was a large multi-center double

blinded study of the benefits versus risks of hormone replacement especially with regards

to coronary health changed all that. The study was prematurely halted as it was found that

there was a small though definite increase in breast cancer risk and increase in

cardiovascular events on these medications as compared to controls. These findings were

widely publicized in the media and caused a wave of panic where most women on these

medications stopped them right away. The study has been scrutinized by experts and

criticized as regards to the conclusions drawn and the age group of the women enrolled in

that the majority of women enrolled was over sixty five years of age with pre-exhibiting

heart disease and not belonging to the age group where symptoms of menopause are most

prevalent. The controversy persists to this day and a myriad of articles are seen both is

scientific journals and lay press both for and against the benefits of hormone replacement

therapy.

So what is a person in the throes of menopause to do? The American College of

Obstetrics and Gynecology recommends the use of hormone replacement therapy in the

lowest dosage that will ameliorate the symptoms and for the shortest period of time

possible. For practical purposes this would involve a visit to your doctor to determine if

hormone replacement therapy is right for you and if so the dosage and duration of

treatment needed which would then be reevaluated at frequent intervals. There are certain

conditions which would contraindicate hormone replacement therapy such as breast or

uterine cancers; strokes or thromboembolic phenomenon , unexplained vaginal bleeding ,

liver disease to mention a few.

There are alternative medications and herbal supplements for hot flashes and use oi‘

calcium and other non hormonal medications can combat bone loss and osteoporosis.

Exercise and a good diet still remains the mainstay of good health at this time of life.

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