A woman’s menstrual cycle is controlled by the hormones estrogen and progesterone circulating in their bloodstream.

As women enter into their 40s and 50s these levels start to decline and she begins to develop the symptoms of peri-menopause or menopause.

These symptoms include hot flashes (flushing), insomnia, bone changes, a lack of a menstrual period and unwanted aging.

Hormone replacement therapy, most commonly done with synthetic estrogen and progesterone, is the most effective treatment for vasomotor symptoms (flushing) and other symptoms of menopause.

However, there are important distinctions that must be made between taking estrogen plus progestin and estrogen alone in terms of benefits and risks.

Conventional wisdom prior to a recent report had been that estrogen may increase the risk of breast cancer in women, especially when taken in combination with progestin for the treatment of the symptoms of menopause.

The recent report from the Women’s Health Initiative, which began in 1991, reported findings that women who have previously had a hysterectomy and take estrogen alone have a markedly reduced risk of breast cancer and heart attack.

However, the positive data pertained to women in their 50s for this benefit as women in their 70s actually experienced a greater incidence of heart attack.

The association of treatment combining estrogen and progestin and an increased risk for breast cancer and heart attack remains true.

So this is the bottom line:

  • Estrogen alone and in your 50s, good.
  • Estrogen alone starting in your 70s not necessarily good and your risk factors need to be considered on an individual basis before taking.
  • Estrogen and progestin should only be used after considering all risks by your Doctor and for a limited duration.

Next week we will look at the alternatives to the synthetic estrogen and progestin hormones known as the bio-identicals.

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