Maybe not. Physicians indicate that up to one third of postmenopausal women do not need ERT. Some menopausal women are able to continue to produce enough estrogen themselves to ward off symptoms and to prevent the metabolic changes that may lead to postmenopausal osteoporosis and, perhaps, to heart disease. The estrogen source for these women may be the adrenal gland, which is located above the kidneys, which may convert its hormone, androstenedione, to estrone (estrogen). This conversion takes place in the fat cells, so overweight women may produce enough estrogen to compensate for their ovaries' cessation of estrogen production.
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These are often the women who sail through menopause. However, these asymptomatic women should also be evaluated by their physicians to make sure that their hormones are balanced. A new study suggests that they need to make sure that they have not become candidates for cancer of the uterus, a situation that may result when estrogen is present without progesterone in women who have an intact uterus. See your doctor!
What can ERT do for me?
ERT or HRT (if you have an intact uterus) can resupply your body with the female sex hormones that will positively affect hundreds of different processes in your body. Estrogen can alleviate menopausal symptoms such as hot flashes, night sweats, vaginal dryness, and other vaginal and pelvic changes; it can prevent postmenopausal osteoporosis; it can offer relief from insomnia; may help with memory loss; may return your desire for sex; may return some of your skin's elasticity; and it may stop the palpitations, mood swings, and the feelings of anxiety and minor depression that may be related to menopausal symptoms. Further, if current research into the cardioprotective effect of estrogen proves this beneficial effect, estrogen may protect you against heart disease and heart attack. That's a pretty compelling list.
Who is not usually considered a good candidate for ERT and HRT?
As I mentioned earlier in this chapter, ERT is not usually indicated for any women who have heart disease or who have had endometrial or breast cancer or any other kind of cancer that is stimulated by estrogen, or any women with a family history of these types of cancer. This will be covered more fully in Chapter 7. Women with chronic or acute liver disease or with genital bleeding that is abnormal and unexplained also are not considered to be good candidates for hormone replacement therapy. Caution is also indicated for women with gallbladder disease and those with diabetes.