Risks Small; Benefits Depend on Individual
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These steps, she says, are much more likely to preserve health than HRT. Both she and Grodstein say HRT should be used only to get over symptoms of menopause, and that long-term use -- five years or more -- isn't advised for prevention of heart or bone disease.
"People shouldn't forget there is value to HRT in some women," Solomon says. "This was ignored at first when WHI came out and there was this widespread panic. It has been a good medicine for years for some women with menopausal symptoms. It is reasonable for symptomatic women who are in the early stages of menopause and who don't have risk factors for the drug. The risks are real, but on an absolute basis they are quite small for young women without other risks of complications. Estrogen helps symptoms enormously."
However, Solomon says there is no convincing evidence that estrogen keeps a woman looking younger, or that it prevents mental decline.
"Women think that they will look better if they're on estrogen," she says. "But if you look for good data to support that contention -- for women to take estrogen with the purpose of looking younger -- there really aren't any. And the other benefit a lot of women hope for is preventing dementia.... I advise my patients that those cannot be considered justifications for taking estrogen."
And what about Wenger's patient with heart disease and terrible menopausal symptoms? After advising her of the risks, Wenger put her back on HRT. She's doing fine now.
"This medicine is for quality of life," Wenger says. "Nothing we do in medicine is riskfree. As long as a woman knows the risks, there is nothing else in our armamentarium to control menopausal symptoms."
Grodstein thinks there are better alternatives than HRT. But she says women have to make up their own minds.
"People have a right to make their own decisions. It is not up to us to tell them right or wrong," she says. "The important thing is to make the decision with the best information available. I think a lot of the problem with HRT it is that we still don't know a lot. This is not a very satisfying answer, but that's where we are."