Menopause.(treatment of symptoms)

taking another look at women's options

The debate over hormone replacement therapy in aging women has become as heated as a menopausal hot flash.

It's no wonder there's growing interest in the topic: An estimated 20 million women in the U.S. are currently in menopause, which is the cessation of menses brought on by decreased production of estrogen, progesterone and testosterone in the body. Fifteen years from now, nearly half of the women in this country will be experiencing "the change," usually at around the age of 51. And although menopause is a natural process, hot flashes, mood swings, vaginal dryness or other health concerns accompany menopause for most American women. (These often begin in the phase just before menopause, called perimenopause, which can last a few years.) The challenge menopausal women face is finding the best way to deal with these symptoms while also helping to stave off diseases associated with aging, particularly in the post-menopausal years.

CONVENTIONAL WISDOM?

Hormone replacement therapy (HRT) has been the conventional medical treatment recommended to help ease menopausal symptoms and to potentially decrease the risk of age-related diseases. A combination of progesterone and estrogen is often prescribed to help compensate for decreased production of these hormones in the body; HRT has been thought to have a protective role against conditions like heart disease and osteoporosis. But women don't have complete confidence in this "one size fits all" approach, as over half of them choose to not use HRT.

One reason for this reluctance may be conflicting information about the pros and cons of estrogen replacement therapy (ERT). For example, many studies support the theory that HRT helps maintain bone density by limiting the breakdown of bone. In this way, ERT may help stave off the bone disease osteoporosis, which becomes more of a threat to women after they menopause, making them prone to fractures. (Supplemental progesterone, usually taken with estrogen therapy may even slightly increase bone density.)

But HRT may increase one's risk of some rare types of breast cancer, according to the findings of the Iowa Women's Health Study, published in the June 9, 1999 issue of The Journal of the American Medical Association. While the study found no correlation between hormone therapy and the most common forms of breast cancer, the potential for increased risk of any form of the disease is still alarming to many women. There are also concerns that high doses of estrogen may increase the risk of endometrial cancer, although combining progesterone with estrogen may lessen the risk.