The HRT proponents scoffed at this simplistic reasoning. They argued that nature makes lots of mistakes (such as allowing cells to grow wildly and cause cancer) and that menopause is one of them. This natural error, they claimed, is why humans are one of the only mammals that develop menopause. Their solution was to replace the missing estrogen.
Over the years, there were scores of studies (most of which, in retrospect, appear to have been flawed) "proving" that HRT protects menopausal woman from a host of ailments. HRT proponents pointed out that it controls hot flashes, mood swings, dry vaginal tissue, aging skin, and brittle bones and also reduces the risk of heart disease, stroke, and Alzheimer's disease. Yes, these doctors (and I was one of them) admitted that estrogen can cause cancer of the uterus, but that can be prevented by adding progesterone. Breast cancer? We're not convinced by the data, they said, and anyway, if every woman had an annual mammogram, it would detect the cancer early enough to cure the disease. All in all, the estrogen school of thought made HRT look easy -- and the evidence supporting its many benefits seemed incontrovertible. More important, millions of women who took these hormone supplements looked and felt much better.
Then came the statisticians and the epidemiologists. One by one, they proved virtually every claim about estrogen wrong. They showed that this hormone doesn't protect against heart attack and stroke but actually causes them! Doubts that estrogen contributes to breast cancer also disappeared. Its few confirmed benefits, such as reducing the severity of osteoporosis and controlling night sweats and hot flashes, were overshadowed by its many dangers.
Here's What's New
One remaining myth about the benefits of estrogen -- it improves memory and slows progression of Alzheimer's -- was refuted in a large double-blind, randomized, placebo-controlled study in 39 clinical centers throughout the United States. The purpose of this research was to assess the effect of HRT on the incidence of dementia and cognitive impairment in women ages 65 and older. Of the 4,500 women in the trial, about half received the standard estrogen-progestin combination; the other half was given a placebo. Researchers found that women who took the hormones for an average of slightly more than 4 years actually had twice the incidence of Alzheimer's or other forms of dementia compared with those taking a placebo! This increase translates into only 23 more cases among every 10,000 women taking the hormone. It doesn't sound like much -- unless you happen to be one of them! Nor did the HRT protect against mild memory loss.
Another study of 16,000 women ages 50 to 79, followed for an average of 5.6 years, was stopped 3 years early because those receiving HRT had a 44 percent increased risk of stroke compared with those on placebo.
The Bottom Line
These studies did not involve women under 65, and in all cases, the estrogen was being taken along with progestin. Subsequent research has yielded similar results when estrogen was taken alone. And these data constitute a strong case for most women not to use these hormones. This recommendation is further strengthened by the report from the government-supported Women's Health Initiative that women taking hormones do have a higher risk of heart attack, stroke, and breast cancer.
Are there any safe alternatives to help control some of the troubling symptoms of estrogen deprivation? If you are experiencing hot flashes and night sweats, you may want to try one of the newer SSRI antidepressants, such as Paxil (paroxetine). However, do so under close doctor supervision.
Some doctors also recommend that women take natural soy products (such as tofu or soymilk) to help minimize the symptoms of menopause. Because soy contains high amounts of isoflavone, or plant estrogen, it may help protect against osteoporosis and relieve such symptoms as vaginal dryness and hot flashes. If none of the soy products help and only estrogen seems to work, take the lowest effective HRT dose for the shortest possible time. If you have vaginal problems such as dryness or irritation, use the topical estrogen creams. They appear to be safe. For the prevention and treatment of osteoporosis, there are many new drugs that work at least as well as estrogen (see below and page 195).
