In the Friend Indeed article (Jan/92), Prior expressed her other concerns, saying:

"There are no convincing data showing that menopausal women [matched by age and all risk factors] have more heart attacks because of their menopausal state... I believe that, for some women, estrogen treatment may increase the risk of heart attack. Estrogen has a known potential to raise blood pressure, to increase the level of triglycerides in the blood and to increase blood clotting....The strongest concern is that a properly controlled, blinded study was performed in which men were given estrogen treatment to prevent a second heart attack. This study had to be stopped after 18 months (instead of the 60 months planned) because the men on estrogen had more heart attacks."

Critics point out that high doses of estrogen were used in the men's study (5.0mg premarin for one group and 2.5mg for the other); Prior counters by saying higher doses of estrogen were also used in the Nurses' study. (1.25 mg to 2.5 mg.)

Hormones And Bone Loss

Estrogen hormone therapy has been widely used to prevent bone loss in menopausal women and to reduce the incidence of fractures. Therapy for at least eight to ten years is usually recommended. Stopping estrogen therapy, even after four years of treatment, can cause rapid acceleration of bone loss. Estrogen, in standard doses, does not appear to increase bone mass.

Most bone loss occurs in the first three to six years after menopause. Smaller amounts of bone loss occur for up to 20 years after menopause. Thus, many experts are now recommending that ERT be started at the onset of menopause.

A recent editorial in the New England Journal of Medicine (Aug 27/92) puts it this way: "If begun soon after menopause, estrogen therapy prevents the early phase of bone loss and decreases the incidence of subsequent osteoporosis related fractures."

However, there is no agreement among doctors as to how long hormones should be continued to prevent bone loss, although many doctors now recommend taking HRT indefinitely.

"When estrogen therapy is begun," continues the same editorial, "it is unclear how long it must be continued to maintain the benefit, because its discontinuation leads to a phase of accelerated bone loss, like that which follows natural menopause, and protection against fractures may therefore be lost five or more years after estrogen therapy is discontinued. Thus, although it is widely believed that five to ten years of estrogen therapy is sufficient to lower the frequency of osteoporosis related fractures, much longer treatment, possibly 20 years or more, is required."

Certain groups of women are at high risk for bone loss and fractures. The details of risk and prevention are outlined in the chapter on osteoporosis. Women at high risk should carefully consider the pros and cons of HRT.

There is a good alternative to taking synthetic hormones for the rest of your life. Dr. John Lee has studied the use of a natural progesterone cream which is applied to the skin, and found it will prevent bone loss even without the addition of estrogen. Other forms of progesterone in oral micronized form or vaginal suppository may also prevent bone loss.

Hormones And Breast Cancer

Hormone replacement therapy after menopause is probably linked to an increased risk of breast cancer, but most researchers think this risk is small, especially when weighed against possible benefits.

Dr. Sidney Wolfe, editor of the Public Citizen Health Research Group Health Letter, disagrees. He testified at the United States Senate Subcommittee on Aging in April 1991, and commented on a recent review of studies on estrogen and breast cancer. (Journal of the American Medical Association Apr 17\91).

"If a woman used estrogen pills for 15 years, she had a 30 percent excess rate of breast cancer. If used for 25 years, a "goal" toward which many doctors are pushing their patients, there would be a 50 percent increased risk of breast cancer... When just the five high quality studies were analyzed, the 15 year risk was an increase of 60 percent in breast cancer and the 25 year risk would be 100 percent or a doubling in the amount of breast cancer.