1. I am afraid to take estrogen after reading about the increase in heart attacks, strokes and breast cancer. Should I take the risk?

The Womens Health Initiative (WHI) did a very large study. They stopped the study early due to an increase in breast cancer, strokes, and clotting problems in year 4. Unfortunately, the newspapers published the results before the data was fully analyzed. The average age of the women entering this study was 63, very different from a newly menopausal woman. 50% of the women were smokers, had high cholesterol or high blood pressure when they entered this study. The research was developed to learn if estrogen or estrogen plus a progestogen would reduce heart problems. The conclusion was "No". When the data was further analyzed, they realized the women at risk were over 70 years old or more than 20 years post menopause. The younger women actually had a decrease in heart attacks, strokes, breast cancer, colon cancer, and fractures. The important issue is timing. Initiating in the first 10 years after menopause gives the most benefit. This is an individual issue and Donna would be happy to discuss your risk factors and potential benefits.
2. Are there benefits to estrogen replacement or is it mainly marketing by the pharmaceutical companies?

Yes, there are many benefits to Hormone Therapy. The primary benefits are:

  • Treats hot flashes.
  • Prevents osteoporosis.
  • Prevents vaginal changes (excessive dryness, thinning tissue).
  • Improves bladder control.
  • May improve skin appearance.
  • May reduce the risk for diabetes.
  • May reduce the risk for colon cancer (further study is needed).
Each individual needs to evaluate their potential risk factors versus benefits. Donna will be happy to help you with this process.
3. Are there risks to hormone therapy?

Yes, there are risks associated with Hormone Therapy.
  • There is an increased risk of stroke (primarily in older women and with higher doses).
  • It can also increase the risk of gallbladder diseases and the need for gallbladder removal.
  • It can increase the risk of blood clots, especially with women having a prior history of blood clots.
  • For women with a uterus (if you have not had a hysterectomy), estrogen alone can increase the risk of uterine cancer. (Estrogen combined with progestin reduces this risk.)
  • There is no apparent effect on the risk of ovarian cancer.
It is important to put these risks and benefits into context. There is risk in not treating your symptoms and there is risk in using hormone therapy. There is risk in taking or not taking any prescribed therapy. Donna is happy to discuss your individual risk factors.
4. What are bio-identical hormones?
Bio-identical hormones are hormones identical to the hormones your body produces. Some Bio-identical homones are manufactured at a compounding pharmacy. Other Bio-identical hormones are FDA approved and available at your local pharmacy. Bio-identical Hormones are covered by most insurance companies.
5. I exercise and take calcium. Do I need to take estrogen to maintain my bones?

Exercise and calcium are helpful with bone metabolism along with an adequate level of vitamin D. However, many studies have shown this is not enough to maintain bone. Again, this is an individual decision and depends on your family history. If you have large bones and the women in your family maintain their height into their 80's and 90's, maybe you don't need estrogen. However, if you are Northern European, have small bones, were more than 50% gray at age 40, and a family history of osteoporosis, you would most likely benefit. The advantage of estrogen over the bisphosphonates (Boniva, Fosamax, etc.) is that it continues normal bone metabolism. It is the only agent shown to reduce all types of fractures in women who have normal bones and osteopenic bones, as well as in women with osteoporosis. When a woman stops taking hormone therapy, she may experience the rapid bone loss typical of perimenopause and early menopause. It is good to get a baseline bone density around age 50 to help with your decision. I am happy to discuss your individual risk factors and order your bone density.
6. Does hormone therapy improve cognitive function (memory and thought processes)?
The answer to this controversial question seems to depend on when hormone therapy begins. Some studies show long-term users of hormone therapy, who started using HT at the beginning of menopause, show better memory function later in life than women who began to use HT later in their menopause. Other studies show starting hormone therapy long after menopause may actually cause some cognitive decline. Clearly, more research is needed before we can know the final answer.
7. I am experiencing low libido. Should I be using testosterone?
This is a very individual issue. There are many factors that influence someone's libido. When measuring testosterone levels, there is no correlation between blood level and that person's libido. Some women have low levels and achieve regular orgasms and enjoy sex. Other women have normal levels and have problems getting aroused. The ovaries produce around 50% of your testosterone. If your ovaries have been removed, testosterone replacement may be beneficial. I have found with many women that replacing the estrogen helps considerably. Estrogen helps rebuild the vaginal skin thickness, increases blood flow to the region and improves lubrication. It is the increased blood flow to the region that improves libido. It is important to have an orgasm once a week to keep the brain chemicals working. Your partner has some influence on these feelings as well. I am happy to discuss your individual issues and see if testosterone might be beneficial. There are no FDA approved testosterone products for women at this time. They need to be prescribed through a compounding pharmacy, which may or may not be covered by your insurance.
8. Do I still need an annual pap smear?
The answer to this question is very individual. We now know that cervical cancer is a sexually transmitted disease. It takes 10-20 years after being exposed to the Human Papillomavirus. After age 30, it is important to be tested for HPV along with your pap smear at least every 3 years. Most evidence is pointing to age 70 when we can stop doing pap smears. It is individual, especially with our high divorce rate and many older, single women. Donna is happy to discuss your individual history and risk factors.