The Case for Estrogen

The Case for Estrogen

The benefits and risks of hormone replacement therapy for women

For women facing menopause, hormone replacement therapy is becoming as common as children attending college or dieting. Nearly 4 in 10 menopausal women say they are taking estrogen, or estrogen and progestin, a substance that mimics a hormone similar to estrogen, to help relieve the discomforts of menopause. These symptoms include the sudden feeling of being overheated known as a “hot flash”, as well as vaginal dryness, mood swings, thinning facial skin, headaches, and depression.

An important factor in helping keep the heart, bones, and skin healthy, estrogen production decreases sharply during menopause, which occurs at the average age of 51. Research has shown that women receiving a regular supplementation of estrogen during and after menopause have a significant lower risk of heart disease, stroke, and osteoporosis, the debilitating condition that causes bones to become fragile and to break. Hormone replacement therapy (HRT) also helps spare many women the physical discomfort that can result from changes in the vagina during menopause. These changes, which include the loss of vaginal elasticity and lubrication, can ruin a woman's libido.

HRT is not without potential side effects, however. One large recent study has suggested that women who use HRT for five or more years after menopause run 30 to 40 percent more risk of developing breast cancer than those who don't. Taking progestin along with estrogen has been found to help protect the uterus against cancer in some studies, but it does not appear to protect against breast cancer.

In addition, the American College of Obstetricians and Gynecologists has reported that about 10 percent of women receiving HRT experience side effects that include breast tenderness, fluid retention, swelling, mood changes, and pelvic cramping.

The Case for Estrogen. Photo by Elena

Different dosages, hormone combinations, and ways of administrating the hormones can be tailored to individual needs. Women in a high-risk group for heart disease or osteoporosis may be prime candidates for estrogen supplements. If a woman has a high risk of contracting breast cancer, her doctor may recommend a low-fat diet and regular exercise instead of estrogen therapy. For those who face a high risk of breast cancer, a doctor may also recommend tamoxifen, an estrogenlike drug that has favorable effects on cholesterol levels and prevents bone loss and breast cancer. But tamoxifen does seem to increase the risk of uterine cancer, and women taking it are advised to undergo periodic examinations to check for uterine changes.

Still more studies are now under way on the benefits and drawbacks of HRT, but most of them won't be completed until a few years. By then, another 20 million women will have entered menopause and will have had to decide whether the benefits of HRT outweigh its uncertainties. The answer is likely to depend on individual risk factors.

Estrogen and Heart Disease

A study of nearly 900 women over the age of 45 found that taking estrogen supplements after menopause significantly increased the level of “good” HDL cholesterol, which prevents heart disease. The levl of “bad” cholesterol, LDL dropped.