Pills, Patches, and Shots

Part 9: Estrogen

But estrogen also is a good example of why it is important to wait until researchers have discovered both benefits and risks of a hormone supplement before it becomes widely used. While many women are helped by estrogen during and after menopause, some are placed at higher risk for certain diseases if they take it. As research yields more information about this carefully studied hormone, it may help clarify who should take estrogen replacement supplements and who should not.

For many women, the helpful effects of estrogen outweigh the possible harmful effects. Estrogen supplements decrease hot flashes and lower the risk for osteoporosis, a bone-thinning disease that often disables older people. Many studies suggest estrogen also lowers the risk for heart disease (the number-one killer of women in the United States) in post menopausal women. Several recent studies, however, showed no protective effect of estrogen against further heart problems or death from heart disease in women who already had heart disease when starting estrogen supplements. Some studies suggest that estrogen may protect against Alzheimer's disease, but this has not yet been proven. However, recent clinical trials of estrogen replacement in post menopausal women with mild to moderate symptoms of Alzheimer's disease have not shown any effects. This is an area of active research.

Yet for all of its promise, estrogen supplementation also has raised a number of serious concerns because some harmful effects are more likely to occur in certain women. For example, most women take a hormone called progestin with their estrogen. Women who do not take progestin have a higher risk of cancer of the uterus (unless they have had a hysterectomy). Estrogen supplements also may raise a woman's risk of getting blood clots, which can block circulation in arteries.

Considerable evidence suggests that long-term use (more than 5 years) of estrogen supplements slightly increases a woman's risk of developing breast cancer. In addition, studies also have shown that the risk of breast cancer may be greater among women using combination estrogen/progestin, compared to estrogen alone. Both groups of hormone users had a higher risk of breast cancer than non-users. Lean women who used estrogen appeared to be at greater risk than heavier women. The risk increased with longer duration of use, and returned to the risk of non-users 5 or more years after use was stopped.

So the decision whether to take estrogen is not a universal "yes." Researchers have studied estrogen for many years. As a result, doctors are better informed about which women are likely to benefit from supplements and about the right doses to prescribe so that the risk of side effects is reduced. But before choosing this treatment, each woman, along with her doctor, should ask herself:

• Is there heart disease in my family?
  
  
• Is there breast cancer in my family?
  
  
• Have I had blood clots before, or has my doctor told me I am prone to blood clots?

The answers to these questions, and other factors, will help a woman and her physician make an informed choice about the use of supplemental estrogen, based on a realistic assessment of her personal risks and benefits.

Keep in mind that even after many years of reliable studies of estrogen, researchers continue to discover information about the benefits and risks of this hormone. As these new findings emerge, women and their doctors may have to reassess their decisions about estrogen supplements.

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