The Estrogen Dilemma
The Estrogen Dilemma

For years, Western medicine has touted the benefits of estrogen. First used in oral contraceptives in the 1960s, then introduced several years later for menopausal hormone replacement therapy (HRT), estrogens now are the most widely prescribed drugs in the United States. An estimated 16 million postmenopausal women currently use HRT, and millions of younger women use estrogen in oral birth control pills. During the next 20 years, 30 million baby boomers will have to decide whether to use HRT during menopause.

Many women have benefited from estrogen-containing medications: They have prevented unwanted pregnancies, slowed osteoporosis, and minimized some symptoms associated with menopause.

However, as researchers probe for answers to concerns that estrogen causes cancer, an increasing number of women are scrutinizing the highly publicized health risks. Last December, the National Toxicology Program of the National Institutes of Health in Bethesda, Md., recommended estrogen be listed as a known cancer-causing agent. (Every two years, this organization updates the list of known and suspected cancer-causing substances and carcinogens). The independent advisory panel's decision was based on a review of hundreds of studies that concluded estrogen increases uterine and endometrial cancer, and to a lesser extent, breast cancer. One scientist on the panel noted that this action might encourage doctors to discuss the risks more with their patients.

Clearly, estrogen therapy risks must be weighed against its benefits. Conventional medical doctors often suggest that menopausal women take HRT, but only 25 percent of postmenopausal women actually take it.

Even when women are faced with the choice of possibly decreasing their risk of heart disease (the most common cause of death among American women) and osteoporosis with HRT, many decline because breast or uterine cancer risk may increase—even if the statistical benefits outweigh the risks.

—D.L.


References:

  1. Morrissey DR, Kirchner JT.
    Management of the climacteric. Options abound to relieve women's midlife symptoms.
    Postgrad Med 2000;108(1):85-8,93-4,97-100.

  2. Torgerson DJ.
    HRT and its impact on the menopause, osteoporosis and breast cancer.
    Expert Opin Pharmacother 2000;1(6):1163-9.

  3. Thomas DJ.
    Benefits and risks of hormone/estrogen replacement.
    Nurs Clin North Am 1996;31(4):815-25.



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