Hormone replacement remains a complex decision

THE BALTIMORE SUN

Millions of women are facing a difficult decision. Should they take hormone replacement pills after menopause?

On the one hand, they are told that estrogen will reduce their risk of osteoporosis and heart disease. On the other, reports have surfaced linking hormone therapy to breast cancer.

Complicating the matter is that there is no consensus. Some studies show a substantially increased incidence of breast cancer (30 to 60 percent) while others demonstrate no elevated risk.

Although estrogen has been prescribed for more than 50 years, some experts estimate that it will be at least another decade before we have a definitive answer to this controversy. Meanwhile, physicians and patients are left in limbo.

Fortunately, there are some alternatives to hormone replacement therapy, and researchers are coming up with more options all the time.

Researchers have demonstrated that calcium and exercise can have a beneficial impact on osteoporosis. There are also medicines that can improve this effect. Calcitonin is already available, though it must be given by injection. When it can be used as a nasal spray it may be more widely accepted.

Fosamax (alendronate) is the newest development for osteoporosis. It has already been recommended for approval by an FDA advisory panel. The drug modifies calcium metabolism and slows bone breakdown, which is usually accelerated after menopause. In tests, women on Fosamax had fewer fractures, lost less height and actually increased bone density, while those on placebo continued to lose bone mass.

Anti-estrogens are another exciting approach. Closest to approval is raloxifene, from Eli Lilly. This drug appears to be as good as estrogen at reducing bone loss and lowering cholesterol. Whether anti-estrogens will reduce the risk of heart disease remains to be determined, but scientists are hopeful. There is also the possibility that such compounds will diminish the possibility of uterine and breast cancer.

There is growing interest in natural approaches to menopausal health concerns. Researchers are looking into the activity of estrogen-like compounds found in plants. They hypothesize that many of these may also act like anti-estrogens in the human body.

Probably most research is focused on soy compounds. Dr. James Anderson and his colleagues at the University of Kentucky recently reported that substituting soy protein for meat can have a beneficial impact on blood cholesterol. Sources of soy protein include soy milk, soy flour, tofu, textured soy protein and meat analogs ("fake meats") made from soy.

Previous research suggests that the Japanese, whose diets are high in soy, are less likely than Americans to die of breast cancer or prostate cancer. Perhaps this may be explained by anti-estrogens in soy products. Certainly these benefits would be welcomed.

Q: My doctor has suggested vitamin E, ginseng and black cohosh as alternatives to estrogen for hot flashes. Can they really help?

A: Although there is little scientific evidence of benefit, some women report that these compounds provide symptomatic relief. Black cohosh and ginseng both appear to have estrogenic activity.

Q: I have a simple but effective home remedy for insect stings. Put baking soda on the sting and slowly drip vinegar over it to make it fizz. Continue until the pain is gone.

A: We have heard about vinegar and baking soda in various combinations for insect stings. One person suggested using an Alka-Seltzer tablet dipped in water or vinegar on the sting.

Joe Graedon is a pharmacologist. Dr. Teresa Graedon is a medical anthropologist and nutrition expert.

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