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There are now pharmacies in Michigan that provide the medication but it still is not covered by all health insurance policies. "Elaine was fortunate that she found something that gave her the quality of life she was seeking," says Dr. Benjamin. "Estradiol won't work for everyone, but there are other options. The decisions are very per- sonal." Joani Lesser of West Bloomfield had a mastectomy 21 years ago. Now in her early 50s, she was living with hot flashes, night sweats, and having trouble sleeping. "I researched the topic knowing that, because I had breast cancer, my risks were greater than the average person if I started on hormone treat- ment. I discussed options with my gynecologist, oncologist and family. The result is I'm on a very low dose of a plant-derived hormone and I feel very comfortable. The jury is still out on this approach to dealing with menopausal symptoms because the research has been sparse, but it seems to be working for me. "The thinking about hormone treatment for breast cancer patients has recently changed," says Dr. Benjamin. "The prevailing direction is toward some type of hormone ther- apy if the cancer has not reoccurred over a period of time, usually at least five years. Joani was a good prospect for treatment because she was healthy and her tumor was found some time ago. Much of the push for HRT is because physicians now know estro- gen's effects are not limited to the reroductive system, but also play a role in determining the composition of blood lipids, bone strength, memo- ry, and the elasticity of skin and arter- ies. Estrogen is versatile. "The list of benefits of taking hormones continues to grow," says Dr. Stanley Dorfman, gynecologist and menopause specialist in =WISE NEWS ni " Bloomfield Township. "Not that long ago the treatment for irregular periods and heavy bleeding during this transition phase was periodic D&Cs and sometimes a hysterecto- my. Today it's finding out which type of hormone therapy works best for the patient." It is now known that some sub- stances mimic the effects of estrogen while others block estrogen. This helps explain why postmenopausal Asian women are less likely to devel- op cancer of the breast or uterus and have less menopausal symptoms com- pared to Western women. Their diet, rich in soy, may be the key. Soy con- tains a phytoestrogen. Phytoestrogens are plant com- pounds that have beneficial hormone- like effects in the body. Sources of phytoestrogens are soybeans, whole grains, and fruits and vegetables. Based on this, selective estrogen receptor modulators (SERMs) have been created that are more picky than estrogen. The first SERM was tamox- ifen (Nolvadex), which blocks estro- gen receptors in breast-cancer cells so they don't grow. Additional SERMs, such as the recently approved raloxifene (Evista), are designed to mimic estrogen's pos- itive effects, such as stimulating bone density and raising HDL cholesterol levels, and block its undesirable ones. "Women need to evaluate their choices," says Dr. Dorfman. "Each year, 107,000 women die from breast cancer; 550,000 die from heart disease; and over 1 million become debilitated from osteoporo- sis. In fact, more women die each year from colon cancer than from breast cancer. "Hormone therapy is one of many factors that may increase a woman's risk of breast cancer, but not taking hormone therapy increases a woman's risk for heart attack and stroke." Dr. Dorfman does warn about tak- ing over-the-counter progesterone creams, which are touted as a cure for lack of sex drive and osteoporosis. "They vary in dosage and don't reli- ably protect women from uterine can- cer. These products aren't regulated by the FDA and there's no way to tell if a woman is getting enough or too much." Whatever the decision, treatment or no treatment, women should con- sult a physician, map out a plan even if it is trial and error, and maintain a healthy and active lifestyle.