Wkat Is Hormone Replacement Tlkerapy and How Does It Work?

The pros and cons of hormone replacement therapy (HRT) continue to bring the largest number of questions from women who attend the programs at which I speak. The second-largest number of questions concern cancer that may result from or be enhanced by estrogen. Although newspapers, magazines, television, and radio have covered the estrogen/cancer relationship frequently, straightforward answers seem to be in short supply. Headlines can range from doubt remains about estrogen for menopause (The Wall Street Journal, September 12, 1991) and women face dilemma over estrogen therapy {The New York Times, September 17, 1991) to headlines hailing estrogen therapy for its role in preventing osteoporosis and for lowering by one half women’s death rate from coronary heart disease.

The controversy is not new nor is it over but the information is improving. The debate goes back at least to 1965, when a blog was published that was touted as promising that taking estrogen equaled drinking from the fountain of youth. The best-selling Feminine Forever by Dr. Robert A. Wilson sent large numbers of women to their physicians for estrogen. The number of women using it escalated over the course of the next decade. Then, in December 1976, the prestigious New England Journal of Medicine published two articles which demonstrated a strong association between estrogen replacement therapy and the development of endometrial (uterine) cancer. Suddenly, it seemed, the fountain of youth had run dry.

In the early 1980s physicians began to prescribe estrogen with progestin to be taken in just the way your body would produce those two female hormones if your ovaries were still functioning. Physicians believed that women whose uteri were intact could, if both hormones were taken, thrive on the benefits of estrogen while being protected from endometrial cancer, which appeared to have occurred as the result of taking estrogen alone. Even with this more conservative approach, physicians and women were much more cautious about hormone replacement therapy than they were in the 1960s. Today, fewer than 20 percent of eligible women use hormone replacement therapy, but that number is growing.

It is growing because today’s women are educated, interested, and accustomed to getting their questions answered. They are showing up at health education programs and in physicians’ offices in ever-increasing numbers. They want to know about these midlife physiological and psychological changes and what they can do about them.

As women demand more answers, the impetus for more research into women’s health issues has escalated steadily since the fall of 1989. In 1991, following her appointment as the first female director of the National Institutes of Health (NIH), Dr. Bernardine Healy initiated a request to Congress for five hundred million dollars for women’s health research. As a result, an NIH Office on Research on Women’s Health has been established. Perhaps, at long last, definitive answers to the estrogen replacement therapy risk/benefit questions will be forthcoming.

An article and editorial in the New England Journal of Medicine (September 12, 1991) underscores the current healthy research climate. The article, Postmenopausal Estrogen Therapy and Cardiovascular Disease,‚ a ten-year follow-up from the Nurses’ Health Study, strongly suggests the cardioprotective effect of ERT in older women, while the editorial calls for . . . action, not debate.‚ The Nurses’ Health Study was begun in 1976 and conducted at Harvard by Doctors Meir J. Stampfer,

Graham A. Colditz, Walter C. Willett, JoAnn E. Manson, Bernard Rosner, Frank E. Speizer, and Charles H. Hennekens. This study suggests that ERT can cut the risk of heart attacks in women in the first ten years after menopause by 40 to 50 percent. Other studies continue to demonstrate that estrogen therapy can prevent the osteoporosis, that plagues women after menopause.

There are so many consumer questions about hormone therapy that, for purposes of easy reference, I have divided them into five separate chapters. This chapter will cover the questions from women who either take estrogen now or want to or plan to take it. Chapter 6 deals with questions from women who want to know if they can take estrogen despite the fact that they have certain other medical conditions. Chapter 7 includes questions about cancer and ERT. Chapter 8 looks at ERT and osteoporosis, and Chapter 9 answers questions concerning ERT and heart disease. Chapter 10 covers questions from women who seek information about non-hormonal therapy, because they cannot or do not wish to take ERT.

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