This is indeed a controversial topic that I cannot do justice in this forum. Based on the Women’s Health Initiative study, it is generally felt that estrogens should be given mainly for the relief of postmenopausal symptoms and for them to be used at the lowest effective dose and for the shortest time needed. In the past, estrogens were also given for osteoporosis and were also given fairly liberally because it was felt that they may prevent dementia and cardiovascular disease. The study showed that they did not prevent cardiovascular disease and that the risks of estrogens (breast cancer, blood clots) slightly outweighed the benefits. However, many women find that estrogens are the only effective way to deal with disabling postmenopausal symptoms. In those situations, and when women do not have any other risks for cancer or blood clots, many physicians are recommending estrogens because the increased risks of these problems with estrogen is relatively low. It is difficult and often very personal decision for women.
About Alan Matsumoto, M.D.
Part-time Faculty, Division of Rheumatology
Johns Hopkins University