Estrogen Replacement Therapy: What Would I Do?

During the last 28 years, I have had the privilege of sharing the most intimate life experiences with my patients. By “sharing” I mean that I’ve been there, providing medical care and advice, as they’ve moved from their reproductive years to menopause and beyond, experiencing all of the changes that accompany those transitions. At the end of the day, much of what I advocate for medically is the result of distilling the best scientific evidence available to answer the question: “What would you do?”

It has been over 10 years since the media-driven frenzy surrounding the Women’s Health Initiative had its profound effect on how women and their doctors approached questions about hormone replacement therapy. By exaggerating risks and ignoring benefits, millions of women were convinced either to stop taking hormones or not to start in the first place. Essentially, the baby was thrown out with the bathwater.

Since that time, however, the data has revealed that when timed appropriately, estrogen therapy is safe and effective at lowering the risks for chronic diseases in women. Because we are living longer, disease prevention and the preservation of quality of life have become central to our health care decisions. With that in mind, it is important to know the facts.

  • Menopause results in a loss of estrogen, which has a profound effect on a number of tissues in the body. Decreasing estrogen levels negatively affect the urinary tract, vagina, skin, skeletal system, cardiovascular system and central nervous system.
  • Cardiovascular disease is the leading killer of women in the United States, with 1 in 2 women dying from heart disease or stroke. This compares to the 1 in 25 women who die of breast cancer.
  • Major osteoporotic fractures from bone loss result in a 10 to 20 percent increased mortality, loss of independence, chronic pain and depression.
  • Data from the WHI contradicted numerous other studies and was obtained from a non-representative population of women in a study with serious design flaws.

A number of ongoing studies are looking at the risks and benefits of estrogen replacement therapy, especially in the areas of breast cancer and cardiovascular disease, but here is what we know today about the primary beneficial preventive effects of estrogen.

  • Estrogen, in relatively low doses, protects against osteoporotic bone fractures.
  • Estrogen effectively treats hot flashes and vaginal dryness, resulting in improved sexual and bladder functions.
  • There is strong evidence that estrogen protects against cardiovascular disease if initiated early in menopause.
  • There is strong evidence that estrogen protects against dementia and Alzheimer’s disease.
  • There is strong evidence that estrogen therapy decreases mortality.
  • There are multiple studies that demonstrate decreased arthritis, colon cancer, memory loss, fat redistribution, tooth loss, Parkinson’s disease and collagen loss.
The timing of estrogen replacement appears to have a major impact on its safety and efficacy, with therapy initiation early in the menopausal process being the safest and most effective approach. The method of estrogen administration also affects its risk profile. By using estrogen preparations that are absorbed through the skin, we can virtually eliminate  the risk of forming blood clots, which can result in heart attack and stroke.

So, what would I do to try to prevent diseases associated with aging and improve my quality of life as I get older?

  • Use the lowest dose of estrogen to treat my menopausal symptoms.
  • Choose a transdermal route of administration.
  • Start early in the menopausal process, before estrogen deficiency has done its dirty deeds.
  • Stay fit by eating right and exercising.
  • Try to avoid the media hype when making health-related decisions.

Treatments continue to change and evolve as science and technology evolves. In May 2016, Golden Gate Obstetrics & Gynecology introduced a cutting edge CO2 Laser Treatment for postmenopausal symptoms. MonaLisa Touch treats symptoms and complaints associated with postmenopausal discomforts. Click here to learn about MonaLisa Touch, the Vaginal Rejuvenation treatment option.


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