Are Estrogens Safe?

QUESTION: Isn't it dangerous to take estrogens? How do I know they are safe
for me, or when a woman should take them?
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ANSWER: Estrogen replacement has become a leading treatment for hot flashes,
osteoporosis, and other conditions once accepted as the inevitable
consequences of menopause. Although it is not suitable for every woman after
menopause, new combinations of estrogen and progesterone therapy, and the
development of several ways to take these medications, are helping many women.
Estrogen replacement therapy seems to be effective for hot flashes,
making them occur less often and less intensively in 98% of the women treated.
However, there are other therapies that may also be helpful for this problem,
which may last a year a more.
A much more serious problem is osteoporosis, which can lead to bone and
hip fractures and serious complications. Since no treatment can reverse
osteoporosis, prevention is the key. Prevention begins before menopause, and
includes a routine of weight-bearing exercise, a diet with calcium and vitamin
D, no smoking, and little drinking of alcoholic beverages.
Mounting evidence suggests that estrogen replacement therapy, along with
progesterone immediately after menopause, can go a long way in preventing bone
loss. The time to begin is based more on menopause than on age, and even if
therapy is begun late, it can still help slow or stop bone loss. Women who
have stopped menstruating because of hysterectomy would be advised to begin
estrogen and progesterone therapy regardless of their age.
Researchers believe that estrogen delays the beginning of atherosclerotic
heart disease in women, and that estrogen replacement therapy lowers the risk
for heart attack (myocardial infarction).
Estrogen suppositories can improve vaginal lubrication and other changes
associated with menopause that can interfere with sexual interest and comfort.
The impact of estrogen therapy and menopause on a woman's emotional state
is still being studied. Research has shown that women given estrogen had more
restful sleep than untreated women. But it is difficult to measure how much
better a woman's memory is, how much less insomnia she has, or whether she is
less depressed before and after estrogen replacement therapy.
The most potentially serious side effect of estrogen replacement is
endometrial carcinoma, a type of cancer that has a higher incidence in treated
women. Estrogen itself does not cause cancer, but it seems to make the uterus
more likely to respond to something that does. Recent reports suggest that
the risk can be reduced by decreasing the dose of estrogen, shortening the
length of time you take it, and by adding progesterone to the therapy.
In light of our current information on estrogen and the safer and more
pleasant ways we have of taking it, it can help many women feel more like they
did before menopause. As women's life expectancy increases, therapies such as
estrogen replacement can help improve the quality of your life.