Risks Small; Benefits Depend on Individual
"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."