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offered tremendous promise to
women approaching menopause.
Early studies and conventional
wisdom suggested that taking
estrogen should prevent heart dis-
ease, stroke, osteoporosis, and
even Alzheimer's disease, along
with almost completely suppress-
ing the most bothersome symptom
of menopause — hot flashes.
Early in the use of ET, an
increase in uterine cancers was
observed, but this risk was virtu-
ally eliminated by adding another
hormone, progesterone (in drugs
such as PremPro.) Other studies
also indicated that ET slightly
increased the risk of breast can-
cer. Because the presumed bene-
fits seemed to outweigh these
small risks, doctors increasingly
prescribed ET in the 1980s and
'90s.
It wasn't until 2002 that the
first randomized clinical trial —
the "gold standard" of medical
research — was completed on ET
The results indicated more risks
for postmenopausal women. As
expected, women on ET showed
a slightly elevated risk of breast
cancer. Surprisingly, they also
exhibited an increase in heart dis-
ease and strokes.
In light of these
findings, most cli-
nicians now choose
to treat or prevent
these conditions
with non-hormonal
approaches when-
ever possible.
Without ET,
how do I reduce
my risk of heart
disease and stroke?
Daniel Hayes, M.D.
The most impor-
tant strategies a
woman can take to reduce her
risk of developing these diseases,
as well as many cancers, are to
avoid or quit smoking, and to
carefully manage high blood pres-
sure and cholesterol.

What about osteoporosis?:
Again, to decrease this risk, don't
smoke. Moderate exercise and tak-
ing 1000mg of calcium daily also
reduce osteoporosis risk. For some
women, osteoporosis advances
despite these measures; they may
need a medication called a bisphos-
phonate (such as Fosomax) to pre-
vent bone resorption.

What about reducing hot
flashes?: This symptom may be
harder to avoid without ET Non-
prescription or "complementary"
therapies including vitamin E, soy,
and black cohash may have some
benefit, but studies have not
proven them much better than
placebos.
Recently, several clinical trials
have demonstrated that medicines
used to treat depression have
reduced hot flashes appreciably in
half or more of the patients stud-
ied. These drugs, too, have side
effects, so a woman should pursue
this option only after discussing the
risks and benefits with her doctor.

Is hormone therapy ever an
option?: Estrogen may still help
some women with hot flashes
and/or osteoporosis if these
conditions are not well con-
trolled with non-hormonal
maneuvers. However, for
most post-menopausal
women, its use should gen-
erally be avoided.
There are no absolute
answers. Every woman
should discuss these issues
with her doctor to arrive at
the best approach for her.
— Daniel Hayes, M.D.
Clinical Director the
Breast Oncology Program
University of Michigan
Comprehensive Cancer Center