Hormone therapy

March 25, 1999|By MEG H. PARTINGTON

Misinformation and temporary side effects often steer women away from something that may strengthen their bones, protect them from heart disease and generally make them feel better.

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The wrong information about hormone replacement therapy can be passed through generations or be found in publications.

"You're dealing with a misunderstanding," says Dr. George Stefenelli, an obstetrician/gynecologist in Waynesboro, Pa. He encourages patients to go to the library and read information from credible sources.

Candidates for hormone replacement include postmenopausal women and those who have had their uteruses or ovaries removed. The therapy also may be prescribed to women who have stopped menstruating early - possibly due to eating disorders or excessive exercise. For the latter group, Stefenelli emphasizes the importance of consulting a gynecologist about the cause.

Many women are concerned about getting breast cancer as a result of hormone therapy, a fear that perpetuates the myth that such cancer is the leading cause of death among women. In reality, heart disease is women's biggest foe.


"There's no question that coronary artery disease and stroke is a major problem for women," says Dr. Scott M. Hamilton, a Hagerstown cardiologist. He says heart disease strikes 4.5 out of nine women, while breast cancer strikes one in nine.

Estrogen often delays the onset of coronary artery disease until menopause, Hamilton says.

But by age 70, women catch up with men in terms of risk for heart problems, says Dr. Loretta Finnegan, director of Community Prevention Study and Community Outreach of Women's Health Initiative, National Heart, Lung and Blood Institute, National Institutes of Health.

"It may be worth the risk to be on the estrogen replacement therapy," Hamilton says, as long as women aren't already at high risk for breast cancer.

Research has shown that hormone therapy can slightly decrease levels of low-density lipoproteins, called "bad cholesterol," and increase the levels of high-density lipoproteins, called "good cholesterol," says Finnegan, also medical adviser to the director of Office of Research on Women's Health.


Hormone replacement therapy has been shown to reduce hot flashes and lower the risk of osteoporosis, or at least slow down the bone deterioration it causes, says Dr. James E. Brown, a Martinsburg, W.Va., obstetrician/gynecologist. Taking 400 milligrams of Vitamin D and 1,200 milligrams of calcium daily helps too, he says.

Hormone therapy also is used to treat bone loss that has already begun, according to National Cancer Institute.

Hormone therapy may slow memory loss in some women, Brown says. Preliminary studies suggest that taking estrogen may reduce the risk of developing Alzheimer's disease, but more research is needed, according to National Cancer Institute.

A decrease in vaginal discomfort is another benefit of taking hormones, according to National Cancer Institute. A reduction in stress incontinence and urinary tract infections is another potential plus, the institute says.

Taking replacement hormones is not the only way to protect your heart and bones.

"There are many things one can do to reduce your risk of heart disease and osteoporosis," Finnegan says. A low-fat diet, exercise, not drinking alcohol excessively or smoking, eating calcium-rich foods and taking supplements are among the options, she says.


While hormone replacement therapy has proven beneficial to menopausal and postmenopausal women, it also has potential downfalls. Concerns are focused on the risk of endometrial cancer and breast cancer, especially after more than 10 years of use, according to National Cancer Institute.

But Finnegan says the length of time women can stay on the therapy is unknown.

When estrogen therapy became available for menopausal women in the 1940s, it was given in high doses without progestin, according to National Cancer Institute. In the 1970s, it was discovered that women who were given estrogen alone had up to a six- to eightfold increased risk of developing cancer of the endometrium - the lining of the uterus.

For a woman who still has her uterus, taking a combination of progestin and estrogen substantially reduces the risk of endometrial cancer associated with taking estrogen alone, the institute says.

Progestin counteracts estrogen's negative effect on the uterus by preventing the overgrowth of the endometrial lining. A woman who has had a hysterectomy can take estrogen alone.

Whether hormone therapy increases a woman's risk for breast cancer continues to be debated. Finnegan says women who are at risk for breast cancer or who have any other major risk factors may want to avoid hormone therapy.

Some other potential side effects of hormone therapy are breast tenderness and break-through vaginal bleeding, Stefenelli says. Water retention may be another side effect, according to the institute.

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