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Hormone Replacement Therapy: One Size Does Not Fit All


Both doctors point out that women have many alternatives to HRT. A new class of drugs called selective estrogen receptor modulators (SERMs), including Evista (raloxifene), has been designed to prevent osteoporosis without the stimulating effect on breast tissue seen with estrogen. However, these drugs are too new for doctors to know what their long-term effects will be. Other drugs also are available that may lower osteoporosis risk, such as Fosamax (alendronate).

Manson reminds women that they can also lower their risk of heart disease and osteoporosis through changes in lifestyle. "Many women may be able to get by without these hormones at all," she says. A diet low in fat and rich in calcium and fiber, along with regular weight-bearing or resistance exercise, could accomplish much of what HRT is meant to do. Says Peters, "Perhaps we have become too dependent on pills rather than making lifestyle changes, because those changes are harder to do."

"There are a lot of options for women to discuss with their doctors," Manson says. Adds Peters, "After weighing all the factors, some women may choose to remain on HRT and just be more diligent about getting follow-up examinations. Others may make other choices. The bottom line is, the patient needs to discuss her concerns with her physician and come up with the decision that's best for her."

Topics to Discuss With Your Physician:

  • Family history of breast cancer, heart disease, and osteoporosis
  • Other risk factors for breast cancer
  • Duration of HRT use
  • Dosage of HRT
  • Perimenopause
  • Alternatives to HRT, including Evista or Fosamax
  • Lifestyle changes
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