This again is an evaluation to be made by your physician. Current medical thinking seems to indicate that you cannot consider ERT if you have a personal or a family history of uterine cancer or estrogen-dependent breast cancer. Chapter 7 discusses this questions more fully.
Does every woman need ERT?
Physicians indicate that up to one third of women do not need ERT. Some menopausal women seem able to make a small amount of estrogen or to convert other hormones to estrogen or to be able to use estrogen that is stored in fatty tissues, compensating to some degree for the ovaries' cessation of estrogen production.
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Often these are the women who sail through menopause. Women whose symptoms are uncomfortable and who have no medical reason not to take estrogen often choose to take ERT. Some women simply cannot take it for medical reasons. The four out of ten postmenopausal women who ultimately will have osteoporosis probably need to discover that they are at high risk as early in their lives as possible. Their physicians will probably encourage them to include calcium-rich foods in their diets, calcium supplementation, plenty of approved exercise, to quit smoking, and to take ERT to reduce their risk. (See Chapter 8 for more on osteoporosis and ERT. )
In terms of protection against coronary heart disease, the indicators seem to support the effectiveness of ERT, but conclusive evidence is still unavailable and large-scale studies of women and heart disease desperately need to be conducted. A 1991 article in the prestigious British medical journal Lancet underscored estrogen's dramatic effect on serum cholesterol levels. Women taking it showed a significant increase in HDL, the good‚ cholesterol, and a decrease in LDL, the bad‚ cholesterol. This is important because this improvement in serum cholesterol levels decreases arterial plaque and thus decreases the obstruction to blood flow in the arteries.
Can I take HRT if I have a benign fibroid TUMOR IN MY BREAST OR UTERUS?
Many women at the programs asked this question. In the past, the presence of fibroid tumors in a woman's breasts or uterus has often been the reason why her physician steered her away from estrogen. The low dose of estrogen used today in replacement therapy has changed the answer to this question from a definite no to a perhaps. Discuss it anew with your physician.
Everyone keeps talking about the patch bypassing THE LIVER AS a GOOD THING. WHY IS THAT? When estrogen passes through the digestive system (as it would if ingested in pill form), the liver extensively metabolizes it, perhaps changing it in some important ways. Current medical theory is that by allowing estrogen to initially bypass the liver, the patch system of estrogen replacement therapy may permit you to use ERT whether or not you have certain other medical conditions such as liver or gallbladder disease, certain forms of hypertension, or other circulatory system problems. Moreover, because the estrogen is not changed in the liver, your dosage is more easily monitored by your physician.
What can be done if you are already on ERT AND YET ALL YOUR UNCOMFORTABLE SYMPTOMS DO NOT DISAPPEAR?
Sometimes changing the kind of estrogen you are taking or increasing the dose will help, but this is not something you can consider without seeing your physician. In the case of hot flashes, many women, including me, have had hot flashes disappear by taking Vitamin E along with ERT. Although there is no scientific proof that Vitamin E alleviates hot flashes, it does appear to help some of us. During the period when I experienced hot flashes and thought they were just sweats induced by stress, I took four hundred milligrams twice a day and the flashes went away. Ask your doctor if you can try Vitamin E.
What can I do about the amount of weight I've gained since beginning ERT?
Estrogen does not increase your weight, but some women insist that it can make you hungrier. About one in four women report a slight weight gain after going on ERT. Whether this is due to water retention or to an actual increase in fatty tissue is not clear, but it still shows on the scale and in how our clothes fit. To add to the problem, our need for estrogen at menopause comes at a time when our metabolism is slowing down, and we may gain weight for that reason as well. More on weight gain, metabolism, and water retention in the chapters on lifestyle, Chapters 13 and 14.