Whether or not to take estrogen after menopause is a complex question. Estrogen replacement therapy reduces some health risks and increases others, and its overall impact on your health requires an evaluation of your individual health history and risk factors. The following factors may be important to your decision:
ERT and Osteoporosis
Estrogen replacement reduces the risk of osteoporosis by slowing bone loss and decreasing fracture rates. Currently, it is the only therapy that does so. It has been estimated that ERT can reduce the risk of osteoporotic fractures by up to 60 percent.
ERT and Heart Disease
Estrogen seems to protect against he development of heart disease, the leading cause of death in post-menopausal women. Primarily, ERT decreases “bad” low-density lipoprotein (LDL) cholesterol and increases “good” high-density lipoprotein (HDL) cholesterol levels. This particular combination lowers the risk of heart disease.
Because risk of death from cardiovascular disease is so much greater than other health risk for postmenopausal women, the “heart protection factor” of ERT may suggest that it is a wise choice for many women.
ERT and Breast Cancer
The jury is still out on ERT and increased risk of breast cancer. Some studies warn of increased risk. Other studies suggest that lower doses of estrogen do not appreciably increase risk of breast cancer even when administered over several years.
Women at high risk for breast cancer may decline ERT. If you do choose ERT, it is important to get a yearly mammogram.
ERT and Endometrial Cancer ERT may increase the risk of endometrial cancer (cancer of the lining of the uterus). Estrogen combined with the hormone progestin seems to protect against this increased risk. On the other hand, adding progestin reduces the estrogen’s ability to lower cholesterol levels.
ERT and Other Considerations
Estrogen replacement greatly reduces discomfort caused by menopausal symptoms such as hot flashes, vaginal dryness, and mood swings. On the other hand, ERT may cause vaginal bleeding, weight gain, nausea, headaches, and breast tenderness.
ERT often requires daily administration. That means you have to remember to take a pill ever day for as long as you continue the therapy.
Who Should Not Take ERT
If you have any of these conditions, ERT is generally not recommended:
- Diagnosed or suspected breast or endometrial (uterine) cancer
- Undiagnosed genital bleeding
- Active liver disease
- Active thromboembolic disease (blood clots)
Should You Take ERT?
Discuss each of the above risks and benefits with your doctor. The best ERT decision depends upon your individual risks. The following guidelines may also be helpful.
- The greater your risk of heart disease, the greater benefits you will receive from ERT. (If you have high cholesterol levels that you are unable to reduce, ERT may be very important to your health.)
- The greater your risk of osteoporosis, the greater benefit you will receive from ERT.
- If you have low cholesterol and strong bones, you may feel that the benefits that you will gain from ERT are not worth the extra risks.
Filed Under: Health Information
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