MEDICAL SURFARI: CUSTOMIZED HORMONE REPLACEMENT THERAPY

This is the second in a series of four articles this month addressing the menopause transition and some of the major health issues that post-menopausal women face.

In biological terms menopause is referred to as the climacteric. This word also has a Greek origin, coming from the word "climakter", meaning a rung of a ladder. Some may debate whether this is the top rung or the bottom rung of the ladder. The difference between these extremes, I believe, depends upon two very important factors. One of these is attitude. There are many things that we cannot change in our life but the remarkable thing is that we have a choice every day about the attitude with which we will embrace the day. The second, and equally as important factor, is an intelligent understanding of menopause and its potential effects so that you may have a current understanding of the issues and discuss them with your physician to determine what is right for you.

During menopause there are fluctuations in the level of hormones produced in the ovaries. After menopause the ovaries no longer effectively produce estrogen. It is these fluctuations in hormone levels that are responsible for many of the unpleasant effects during the menopausal transition. Since the average woman will be post-menopausal for about one-third of her life, she will need to make a very important decision about hormone replacement therapy.

Hormone replacement therapy (HRT), sometimes referred to as estrogen replacement therapy (ERT), helps to restore your estrogen level by means of a pill or a skin patch. Although HRT effectively alleviates many of the unpleasant effects associated with falling estrogen levels, there are some long-term issues that must be considered when deciding whether or not to take this therapy. Osteoporosis and heart disease are major health risk factors for post-menopausal women and estrogen helps to reduce these risks. However, HRT is not without risks as it is not recommended for women who have a history or strong family history of breast cancer, endometrial cancer (cancer of the uterine lining), uterine fibroids or liver disease. Initially women were treated with estrogen alone, but now hormone replacement therapy includes another hormone---progesterone. This hormone was added since scientists discovered that ERT posed an increased risk of cancer of the uterine lining. By adding progesterone this risk has nearly been eliminated.

Clearly, the greatest fear that seems to fuel the debate about whether to take HRT is the fear of breast cancer. However, in weighing the risks and benefits, you must know that heart disease is the most prevalent cause of death for American women. About five times as many women die of coronary heart disease as those who die of breast cancer. Although HRT can reduce your risks linked to cardiovascular disease and osteoporosis by half, as many as two-thirds of women who start HRT stop within two years. The main reason is the side effects, particularly the problem of irregular bleeding. Just as with any medication, the dosage must be adjusted for the individual and it often can be customized so that you may reap the benefits of HRT without the side effects. Your decision about HRT should be based upon a survey of your risk factors for coronary heart disease, osteoporosis as well as breast and endometrial cancer. Be sure to discuss these issues and your risk factors with your physician before you make your decision.

Remember, especially is you are pre-menopausal, you may take important steps to reduce your health risks by quitting smoking, exercising regularly and increasing your daily intake of calcium. These will help to keep you at the top rung of life's ladder.

World Wide Web Resources

Mayo Clinic

www.mayohealth.org/mayo/9502/htm/estrogen.htm

This web page has a good article titled "Estrogen replacement therapy: Is it right for you?" that addresses the issues to consider with hormone replacement therapy.

Is Hormone Replacement Therapy a Risk?

www.sciam.com/0996issue/0996davidson.html

This article from the Scientific American discusses the current controversies related to hormone replacement therapy.

GIBBS CREDIT LINE

Dr. Scott Gibbs is a Cape Girardeau neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may e-mail questions to him at drgibbs@semissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, Mo., 63701.