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More risk than benefit to replacing hormones

BY DR. DAVID LIPSCHITZ Published: June 18, 2012

For many years, the use of hormone replacement therapy after menopause in women was felt to be invaluable in preventing disease and slowing the aging process — allowing women to remain forever young.

In those days, virtually every one received hormone replacement. In the field of geriatrics, it was not uncommon to initiate hormone replacement therapy in women beyond the age of 70, based on the common belief that heart disease would be prevented and memory loss slowed.

Then came a landmark study from the Women's Health Initiative comparing hormone replacement therapy to a placebo (sugar pills).

Women who had undergone a hysterectomy received estrogen alone. Those with a uterus received estrogen plus progesterone. The trial was abruptly discontinued because of the high risk of breast cancer, strokes, heart disease and venous blood clots.

Since this report, published more than a decade ago, there has been a decline in the incidence and deaths from breast cancer, ascribed to fewer women receiving hormone replacement. And today hormone replacement is virtually never prescribed initially in late life.

Despite this information, many experts believe that hormone replacement therapy is valuable. They belong to a group of "anti-aging" experts who maintain that to be effective, hormone replacement must be individualized and tailored to the unique physiology of the individual woman.

They are convinced that continued use of hormone replacement truly retards the aging process, promotes more vibrant skin, reduces wrinkles and assures a better sex life. However, the vast majority of the health care community does not share this point of view.

Nevertheless, their position has been bolstered somewhat by the fact that hormone replacement is effective in treating osteoporosis, while other commonly used medications to build bone and prevent fractures — bisphosphonates — are not without significant side effects.

Some evidence suggests that most of the adverse effects of hormone replacement therapy are due to progesterone. For women who are able to take estrogen treatment alone, the risks of breast cancer and heart disease are much lower.

While there is no question that hormone replacement therapy should be used for post-menopausal women who have symptoms such as hot flashes, mood disorders and headaches, their use to treat chronic conditions such as osteoporosis still remains questionable.

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