Menopause is confusing and so is the data that surrounds it - especially when it comes to the issue of hormone replacement therapy (HRT).
Yet new information just released from credible medical sources is shedding valuable light on a murky subject that certainly needs illumination. For women who are considering HRT, what you are about to learn will certainly help you clarify your options.
The first breakthrough is considered good news for many women who are facing treatment decisions. Researchers at the Osteoporosis Research Center of Creighton University School of Medicine just reported key findings in the medical journal, Annals of Internal Medicine. Exploring alternatives for standard dose HRT, Dr. Robert Heaney and colleagues discovered for the first time in a controlled study that women who received calcium and Vitamin D supplements required half of the lowest dose of estrogen previously thought to be necessary to avert osteoporosis. This is a condition defined by the National Institutes of Health as "a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture." Bone loss essentially leads to fractures, diminished quality of life, increased nursing home admissions, disability and death.
The Creighton research team carefully studied 128 women over the age of 65 for 3.5 years. Of great importance is the fact that women receiving lower dose estrogen (only 0.3 mg./day) actually manifested greater increases in spinal bone, forearm and total bone density than women taking the standard estrogen dose without the supplements.
This finding is especially relevant to the ongoing duel in medical circles pitting the virtues of HRT such as preventing bone loss with its dangers and side-effects. According to the researchers, "side effects such as weight gain, breast tenderness, spotting, pelvic discomfort and mood changes disappeared within 6 months" when lower dose estrogen was prescribed.
The bottom line - according to Dr. Heaney, "If bone cells are to grow, they need materials. Many of us in the medical profession have ignored the need to provide an adequate number of building blocks."
This physician agrees and strongly suggests that you consider and discuss the issue with your physician, especially in light another recent breakthrough reported in the Journal, Cancer by Dr. Christopher Li of the world-renowned Fred Hutchinson Cancer Research Center in Seattle. Dr. Li and colleagues reported that the incidence of lobular carcinoma, (roughly 10% of all breast cancer cases) has risen considerably since the advent of combined estrogen-progestin treatment in the 1980s. They found that using combination therapy for at least six months has the potential to more than double the risk for developing this form of cancer.
These findings are critically important given the fact that of the 20 plus million women taking HRT in the US, roughly 8.6 million are using combination treatment.
It is essential to understand the rationale for adding progestin is to lower the risk of developing endometrial (uterine) cancer associated with taking estrogen supplements alone. If one combines these two studies, and you consider the insights revealed through these research projects in the step-wise fashion presented below, it becomes readily apparent (bear with me) that:
- Calcium and Vitamin D supplementation halves the dose of estrogen previously thought to be required to prevent osteoporosis and ...
- a lower dose of estrogen could possibly diminish the risk of uterine cancer, therefore ...
- potentially eliminating the need for progestin, thereby ...
- reducing the risk for lobular breast carcinoma which has now shown to be clearly associated with estrogen/progestin combinations rather than estrogen alone!
Through ongoing research, we may learn that reducing the dose of estrogen, eliminating progestin and adding Calcium and Vitamin D supplements will result in three major benefits - reversing osteoporosis and lowering the risks for endometrial and lobular breast cancer.
Please note that I am not suggesting you immediately discontinue estrogen. It has been well-established that estrogen plays a significant role in preventing heart disease, lowering cholesterol and improving symptoms of menopause. What I am proposing however, is the consideration of using less estrogen in combination with Calcium and Vitamin D rather than progestin based upon these reported findings. Further research is needed to determine whether or not lower levels of estrogen can ensure the same health benefits.
Ultimately, it makes a great deal of sense to learn as much as you can about your choices that will impact your quality of life and longevity. Next time you’re face to face with your doctor, take time to discuss these issues and establish yourself as an active member of your healthcare team. What's on your mind is bound to affect your body
-- Mind Over Matter!
© 2000 Barry Bittman,
MD all rights reserved