Pros and cons of estrogen replacement


Q: I just turned 50 and have begun to have mild menopausal symptoms. I am confused by the many pros and cons about the use of estrogen replacement therapy after menopause. What is your opinion?

A: Two unquestioned benefits of estrogen replacement therapare easing or eliminating menopausal symptoms, such as hot flashes, and reducing the risk of developing osteoporosis. Although the evidence is not yet conclusive, most studies have shown estrogen therapy also improves the levels of certain blood lipids and reduces the risk of a heart attack. On the negative side, estrogen replacement clearly increases the danger of uterine cancer and possibly increases the danger of breast cancer.

While many women barely notice menopausal symptoms, about 10 percent have severe ones. It seems quite reasonable to use estrogen replacement when these symptoms are very troublesome. And symptoms usually do not recur if estrogen is discontinued after a few years.

So the real question is whether estrogen replacement therapy should be initiated and continued in all women, whether they have severe menopausal symptoms or not.

In my opinion estrogen replacement therapy is a wise choice for most women. Estrogen prevents the loss of bone calcium that otherwise inevitably begins with menopause and may culminate with osteoporosis. The susceptibility of women to heart attacks rises dramatically after menopause, and my interpretation of the available evidence is that estrogen replacement significantly lowers the risk of a heart attack. The use of a second hormone -- progesterone -- along with estrogen greatly reduces the likelihood of uterine cancer. Any possible increases in the dangers of both uterine and breast cancers are far smaller than the increased risk of heart disease.

You and your doctor need to make a decision after a frank discussion of the benefits and risks of estrogen replacement therapy for you.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine and associate dean for academic affairs at the school.

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