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.