Estrogen Replacement (ERT)
ERT May Not Be for All Women
Many women are confused about the benefits of estrogen replacement therapy (ERT) after menopause because so many conflicting reports have been published. Hot flashes, headache, night sweats, nausea and dizziness occur when the ovaries stop producing estrogen at menopause. Estrogen prevents these symptoms. ERT has also been found to strengthen bones and to protect against heart disease, a leading killer of older women. But cells lining the uterus and in the breast undergo changes at menopause. Since taking estrogen for many years is linked to an increased risk of breast cancer, women at high risk of developing breast cancer may not be good candidates for ERT.
Estrogen replacement therapy may keep bones strong and protect against heart disease.
Estrogen’s Effects on Women
After menopause, the average woman today will live 30 years without the benefit of natural estrogen. Estrogen protects women from heart disease, weakened bones, dry skin and the symptoms of menopause, such as hot flashes and anxiety. Yet only 15% of women take estrogen therapies. Some women believe that estrogen replacement is not a “natural” part of aging. Others do not want the side effects that may come from their use. The estrogen products available today stimulate growth of cells in the breast, which increases the risk of breast cancer, and the cells of the lining of the uterus. Most doctors agree that estrogen combined with progestin protects against the threat of uterine cancer in women with an intact uterus. For most women, the threat of breast and uterine cancer is why they do not take estrogen. The effects of estrogen replacement are described below.
Symptoms of Menopause: The hot flashes, depression, anxiety, insomnia, fatigue and loss of sexual desire associated with menopause are relieved by estrogen replacement therapy.
Heart Protection: Estrogen protects postmenopausal women from heart disease. Women with risk factors for cardiac disease, such as high blood pressure, smoking, obesity or high cholesterol, may especially benefit from estrogen. Estrogen lowers total cholesterol and low-density cholesterol and increases high-density cholesterol, the so-called “good” cholesterol.
Bones: Osteoporosis resulting from menopause weakens bones and may lead to serious fractures in later life. About 65,000 women die after suffering hip fractures. Estrogen protects women from osteoporosis and weakening of bone.
Breast Cancer: The risk of breast cancer is about 25% greater for women who take estrogen for 10-20 years continuously. The risk of breast cancer does not appear to be greater for women who take estrogen for five years or less compared with women who do not take estrogen.
Endometrial Lining: Cells in the uterine lining grow more rapidly when estrogen alone is taken after menopause by women with an intact uterus. This risk can be eliminated by adding progestin to the estrogen supplement. If estrogen is taken alone, careful monitoring for endometrial changes must be done on a regular basis.
Other Effects: Estrogen deficiency causes skin to become dry and to lose its elasticity. Vaginal irritation and infection are more common and vaginal dryness can result in painful intercourse. Estrogen deficiency may cause inflammation of the uterus or bladder lining.
New Research: New estrogen therapies are being developed to protect against heart disease and osteoporosis without increasing the risk of breast cancer. In the meantime, most doctors agree that estrogen can be safely used for five years to treat menopausal symptoms in most women without an increase in breast cancer risk. For those women with a high risk of heart disease and a low risk of breast cancer, estrogen may be useful even when taken for longer periods. The risk of breast cancer may outweigh the benefits of estrogen replacement in women who already have a higher risk of developing breast cancer. The decision to take estrogen or other hormone replacement therapy should be made after careful discussion with your doctor about the risks and benefits in light of your medical history.