Monday, February 27, 2012

If there’s an Estrogen Deficit, why not just give some?

OK, that’s a very good question. But it comes with a very complicated answer – not impossible, just complicated. The use of estrogen or, more accurately, estrogen and progesterone (Hormone Therapy or HT) must be individualized according to the treatment goals of the individual woman. The prescription cannot be standard because people aren’t standard. The relationship between benefit of therapy and risk of therapy isn’t the same for everyone and even changes for each individual as she changes with time, her needs, and her risks.

Benefits relate to symptoms and these can be very different among individuals. But therapy has the potential to help vasomotor symptoms (“hot flashes”), vaginal atrophy, difficulty with sexual relations, osteoporosis, and other problems that influence quality of life.

None of the benefits come without some risk or potential risks. These are related to the baseline disease risks (those the woman already has when menopause occurs or those she is more likely than others to develop), her age, age at menopause, cause of menopause, time since menopause, prior hormonal use, and medical conditions that do occur during treatment.

The “media” and regular people are very aware of some benefits that can be gained from HT, although knowledge is often sketchy and centers around the elimination of hot flashes to the exclusion of many other good things. But it is the risk of HT that provokes the generation of miles of newspaper columns and hours of videotapes. Almost all the risk discussion centers around breast cancer. There has been an enormous amount of discussion and debate about this complex topic, reflecting the differences in research information and academic opinion.

More posts will follow to discuss not only this issue, but also:

  • Vasomotor Symptoms
  • Vaginal Symptoms
  • Sexual Function
  • Urinary Function
  • Weight Osteoporosis
  • Cardiovascular Effects
  • Diabetes
  • Endometrial Cancer
  • Ovarian Cancer
  • Lung Cancer
  • Mood and Depression
  • Premature Menopause
  • Total Mortality
  • Hormone Treatment

Menopause is no small topic. Many issues and many millions of women are involved.

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