Estrogen therapy is now seen as the kiss of death by many alarmed women and is also, considered a ?last resort? treatment by many healthcare providers. This perception stems from an avalanche of news reports linking estrogen replacement therapy to an increased risk for breast cancer. And it appears that in some cases this connection is real.
But like many medical news stories, incomplete reporting and the absence of medical background often create needless worry and lead to more confusion than enlightenment. For the news reader or television viewer, it?s difficult to sort through the flood of conflicting data, with its often-sensationalized media spin, to arrive at what all the controversy means for them. So I'd like to weigh in on the issue of women?s hormone replacement therapy and the concerns raised by the recent Women's Health Initiative Study that has sparked all the press. I will focus on the "big picture" issues, since general concepts ? not personal medical advice ? are what I wish to share.
Breast cancer is scary, dangerous, and common. Approximately 1 in 8 women or about 13% are expected to get the disease, and combined estrogen/progesterone replacement therapy makes things worse. But by how much? The very highest estimates run at about a 20% higher risk, raising a 13% risk to about a 15% risk at most. This, obviously, is not a good thing, yet the question so rarely asked in medical news stories or by many people making health-related decisions is this: "What are the risks of deciding not to take hormone replacement?"
Until recently, those risks were considerable. Thin bones leading to fractures of the hip, spine, and elsewhere remain a terribly common cause of death and disability in elderly women; one in four, it is estimated, will have a major fracture and one in four of these people will die within a year as a result. Hormone replacement has been a major player in preventing this loss of life and function. Any reader who's dealt with these injuries, in themselves or a family member, knows what I'm talking about. Fortunately, alternatives to estrogen are now available to help re-grow bone; some even reduce breast cancer risk at the same time.
So why would any woman take estrogen? The answer is simple and personal: some women simply feel and function much better on hormone replacement. Estrogen clearly prevents hot flashes and excessive sweating and will improve atrophied (thin, fragile) vaginal tissue for proper responsiveness in sexual functioning. Much less open to objective study are the benefits in concentration, mood, memory, libido, headache suppression, and overall sense of wellbeing that a subset of women clearly experience with hormone replacement.
What are the best estrogen "rules of engagement"? In my practice, I use these guidelines:
1. Understand that NOT taking estrogen conveys very little protection from breast cancer. If your risk goes from 15% down to 13%, so what? Both are huge risks. Mammograms, self-examination, and a healthy dose of "breast cancer paranoia" are vital healthcare tools for all women.
2. Understand that this recently-published information is based on combination estrogen/progesterone therapy only, not estrogen therapy given by itself. The part of the study that looked at estrogen-only hormone replacement showed no association with a higher breast cancer rate.
3. Don't feel you must use estrogen to prevent osteoporosis (weakened bones). We have alternatives that are just as good and may be safer.
4. Estrogen does not appear to help prevent heart disease as was once hoped. Don't use it for that purpose.
5. There is significant risk associated with the use of all estrogens, including birth control pills, if you have a history of blood clots or if you smoke.
6. Topical estrogen can be used VERY effectively to treat vaginal dryness, reducing the amount reaching breast tissue and the body in general.
7. Last, but very important: if you know in your heart that your mental, emotional, or physical life is fuller when using some form of estrogen, don't throw the baby out with the bathwater. The increased risk of breast cancer or other danger is very small, while, in this select group of women, the estrogen-related benefits are likely to be far greater than for the population at large. For more information, visit http://www.drjohncorso.com.
We sometimes forget that risks are inherent in everything we choose to do and in everything we choose to not do. The risks of poor memory, mood disorders, disrupted sexual relationships, etc., are difficult to quantify. Yet they should not be automatically subjugated to overstated dangers loudly proclaimed in our alarmist media. If life is better for an individual when using hormone replacement, she should work closely with her physician to screen properly for breast cancer and any other concerns while on the therapy.
In the real world, a little well-placed paranoia can save lives. Thousands of women die every year from breast cancers that slip through the cracks of missed mammograms. Increased screening diligence, linked to the cautious use of hormone therapy, could actually go a long way to prevent these needless cancer deaths.
