Forever Female – The Case For Estrogen.

1. Forever Female – The Case For Estrogen. Robert Grimshaw, MD FACP A Lifetime of Quality Care That’s Convenient & Complete

2. Forever Female – The Case For Estrogen: A striking case can be made for the use of hormonal replacement therapy in post-menopausal women: Quality of Life--You Live Better:a) You don't get (as) fat -- and if you do gain weight, you put it on your hips and buttocks (pear shape), not the more dangerous area of the waist (apple shape).b) Your skin looks younger with less wrinkles are more moisture.c) You remain stronger (bone, muscle, cartilage).d) You have less joint aches (arthralgias)e) You get less urinary infections.f) You have less vaginal dryness.g) You have less pain on intercourse.h) You think more clearly -- there is early evidence that the incidence of Alzheimer's disease is reduced in women on estrogen.i) You feel more energy, less fatigue, sleep better, have less head-aches, palpitations and flushes.j) You keep more of your teeth.

3. Quantity of Life --You Live Longer: a) Decreased heart disease. The rate of coronary disease goes down 50%.  This compares with a relative risk of menopause of 317%!  And recent additional data shows women who’ve had bypass surgery are more likely to survive on estrogen -- 98.8% vs 82% for nonusers after 5 years.b) Decreased stroke.  The stroke rate on estrogen is 31% less, and death rate from stroke 63% less.c) Decreased diabetes. In one analysis, risk dropped by 32%.d) Increased bone strength, decreased fracture risk.  As we have noted in these pages before, one million post-menopausal women will break a bone this year.  300,000 will break a hip.  100,000 will wind up in a nursing home, and 60,000 will die.  Vertebral compression fractures, which lead to substantial loss in height,  will occur in nearly one woman in four after menopause.e) Decreased risk of hypertension.f) Decreased risk of colon cancer.g) Decreased risk of ovarian cancer (by 37% in one 1994 study).h) Decreased risk of blocked arteries to the legs. (Peripheral vascular disease.)On balance, a study in the Journal of the AMA says, women gain between 4 and 41 months of life with estrogen.

4. What's the Downside? As always, there is no perfect pill.a) Uterine cancer. This risk occurs only with the use of estrogen only in women who still have a uterus.  It  has now been eliminated by use of progestins either simultaneously or in a cycle that mimics a normal period.  b) Breast cancer.  This remains quite controversial, but there is substantial evidence of a small, but measurable, rise in breast cancer in women on estrogen.  This makes biologic sense, since a large number of breast cancers are dependent on estrogen for growth.  But it's a small effect -- a relative risk between 15 and 74% higher.  This compare with a 100% increase with obesity, a 100% increase with never having had children,  a 200% increase with a high fat diet, and 500% increase with excess alcohol! And analysis of 122,000 women in Boston’s Nurses’ Health Study showed that only women who drank had the increased breast cancer risk.

5. Forms of Estrogen Include: pills (Premarin,  others), combinations (PremPro), patches (Climera,Alora,  Estraderm) and creams.  The data on pills is better than that for patches and creams.  Sources: Sandra Raff, M.D., director of endocrinology at New Britain (Conn) Hospital, JAMA, others.