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Risk Than Benefit to Replacing Hormones
Dr. David Lipschitz
many years, the use of hormone replacement therapy after menopause
in women was felt to be invaluable in preventing disease and slowing
the aging process — allowing women to remain forever young.
In those days, virtually every one received hormone replacement.
In the field of geriatrics, it was not uncommon to initiate hormone
replacement therapy in women beyond the age of 70, based on the common
belief that heart disease would be prevented and memory loss slowed.
Then came a landmark study from the Women’s Health Initiative comparing
hormone replacement therapy to a placebo (sugar pills). Women who had undergone
a hysterectomy received estrogen alone. Those with a uterus received estrogen
plus progesterone. The trial was abruptly discontinued because of the high risk
of breast cancer, strokes, heart disease and venous blood clots.
Since this report, published more than a decade ago, there has been a decline
in the incidence and deaths from breast cancer, ascribed to fewer women receiving
hormone replacement. And today hormone replacement is virtually never prescribed
initially in late life.
Despite this information, many experts believe that hormone replacement therapy
is valuable. They belong to a group of “anti-aging” experts who maintain
that to be effective, hormone replacement must be individualized and tailored
to the unique physiology of the individual woman. They are convinced that continued
use of hormone replacement truly retards the aging process, promotes more vibrant
skin, reduces wrinkles and assures a better sex life. However, the vast majority
of the health care community does not share this point of view.
Nevertheless, their position has been bolstered somewhat by the fact that hormone
replacement is effective in treating osteoporosis, while other commonly used
medications to build bone and prevent fractures — bisphosphonates — are
not without significant side effects.
Some evidence suggests that most of the adverse effects of hormone replacement
therapy are due to progesterone. For women who are able to take estrogen treatment
alone, the risks of breast cancer and heart disease are much lower.
While there is no question that hormone replacement therapy should be used for
post-menopausal women who have symptoms such as hot flashes, mood disorders and
headaches, their use to treat chronic conditions such as osteoporosis still remains
questionable. To address this problem, the U.S. Preventive Services Task Force
has just issued a recommendation, published in Annals of Internal Medicine, that
hormone replacement therapy should not be used to treat any chronic condition,
In this report, the task force notes that combined estrogen-progesterone therapy
does reduce the risk of fractures in post-menopausal women and may lower the
risk of diabetes. They also note that estrogen treatment alone reduces fracture
risk, decreases the risk of the more dangerous invasive breast cancer and even
reduces the risk of breast-cancer death.
Despite these benefits, the task force strongly recommends against the use of
hormone replacement therapy. They note that women taking estrogen and progesterone
therapy have a higher risk of invasive breast cancer and deaths from breast cancer.
These women are more prone to have strokes, blood clots in the legs and lungs,
gall bladder disease, memory loss, urinary incontinence and deaths from lung
cancer. Migraines and heart attacks also are more prevalent.
And estrogen therapy alone is not safe. Strokes, blood clots in the legs and
lung, gall bladder disease and urinary incontinence are frequent side effects.
Based on all these facts, most experts believe that hormone replacement therapy
should be limited exclusively to women who have symptoms after menopause. The
lowest dose of hormones needed to relieve symptoms should be prescribed and treatment
should be continued for as short a period of time as possible. After menopause,
women are more likely to develop chronic disease such as osteoporosis, diabetes,
hypertension and heart disease. Every woman should be appropriately screened
for these disorders. When needed, highly effective and relatively safe medications
Sadly, there is no “fountain of youth,” and aging is inevitable and
normal. To date, neither hormone replacement therapy nor any other medication
can make us either feel or be younger.
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