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Up until recently, women were advised that taking hormone replacement therapy would protect them from developing heart disease. Last year a study suggested that women with existing heart disease should not use estrogen.
Most recently, the Women's Health Initiative Randomized Controlled Trail in the United States was interrupted three years early. It concluded that "Overall health risk exceeded benefits from use of combined estrogen plus progestin for an average 5.2 year follow-up among healthy postmenopausal US women…the results indicate that this regimen should not be initiated or continued for primary prevention of CHD" (coronary heart disease).
The trial showed that the risk of CHD appeared in the first year and stroke in the second year and breast cancer after several years. The risk translated into 7 more coronary heart disease events, 8 more strokes and 8 more pulmonary embolism (blood clots to the lungs) and 8 more invasive breast cancers per 10,000 women per year.
Given the concerns of HRT and the risks recently disclosed by a NIH study, many women who are presently on HRT want to go off it. To do so requires a weaning off period. This will decrease the risk of rebound symptoms of menopause such as hot flashes, night sweats and irritability.
An appropriate method to wean off HRT is to simply gradually reduce the dose. This can be done over a three to six month period. To ease the transition, women might want to consider initially loading up with phytoestrogens, particularly isoflavones one month prior to the start of the weaning off HRT process. Isoflavones alone in sufficiently high doses can reduce hot flashes and night sweats. Therefore loading up on isoflavones reduces the breakthrough menopausal symptoms related to decreasing hormone levels. Isoflavones should be continually taken during the weaning off period and afterwards to maintain general well being.
After women go off HRT, they should consider other products to deal with medical and symptomatic issues related to menopause. Heart disease can be reduced with appropriate cholesterol control, good blood pressure levels, lifestyle issues such as exercise and eating a healthy diet. Osteoporosis disease can be treated with other specific medications, good diet, appropriate supplementation and exercise. Sexual function can be improved with local depo-estrogens that are non-systemic (ie. estrogen that work locally in the vagina and does not enter the general blood supply to reach other parts of the body). Testosterone and testosterone-like herbal supplements can assist in improving libido (sexual desire).
Contributed by Elaine Chin, M.D., Medical Director of the Beresford Clinics.