CHARLESTON, W.Va. -- We are rightfully very concerned about the cost of medical care these days. A major and very useful suggestion has been to emphasize preventive care. I couldn't agree more. So why don't we consider much more seriously hormone replacement therapy for women?
To do that, we have to learn to think anew -- doctors and patients -- and that's never easy.
I know "hormone replacement therapy causes breast cancer." That's what everyone says, but it's not true. Still, that's all anyone remembers from the Women's Health Initiative report in 2002.
Any cancer deaths are unfortunate, of course, but the worst the report could show was an increase in deaths of 3 to 4 per 10,000 treated women. The second arm of the study reported later and using estrogens alone showed no increased risk of breast cancer at all, not even for women who had already been cured of a previous breast cancer. The 2002 study was so poorly done in many ways it is almost useless. We must get it out of our minds and look elsewhere for guidance.
Studies done around the world agree that hormone replacement therapy protects in a big way against osteoporosis and subsequent fractures. Did you know that a senior suffering a hip fracture is 70 percent likely to be dead within the following year? There's a biggy for you.
Furthermore, bisphosphonates (like Fosamax) are not an adequate substitute. By corrupting the bone building process, bisphosphonates make bones dense, but not strong. The bones look good on bone density studies, but that's a fooler. They do not protect against osteoporotic fractures, and after years of use bizarre and unusual fractures have begun to show up.
Women have ovaries that from puberty until menopause secrete three steroid hormones -- estrogen, progesterone and testosterone. They are active in the nucleus of every cell in the body, from the head to the toes. They support connective tissue, skin, muscle, glands, bone, heart and brain. Why doesn't your uterus fall down through your vagina? Actually it tends to do just that without estrogen. And your bladder tends to be incontinent. And your spinal discs collapse. And you are more likely to gain weight and have adult onset diabetes and have your blood pressure go up and have heart problems. That is what we are setting ourselves up for by not replacing our disappearing ovarian hormones. Remember, too, that nowadays with prolonged life span, women spend at least one-third of their lives in the menopausal state with ovarian hormone deficiency.
People don't like to talk about sex very much, but the fact is some people enjoy it. Definitely we know there is a market for Viagra and similar drugs. Who are those men having sex with? Could it be their wives? Maybe yes, if their wives are taking hormone replacement. Women can enjoy sex more if their vagina actively makes secretions and its tissues are stronger than wet toilet paper. That happens with hormone replacement therapy. A female appropriate dose of testosterone also stimulates positive sexual sensation and responses.
Recent national and international studies are pointing to the likelihood that hormone replacement therapy protects against Alzheimer's disease. How is that for preventive medicine? If only a part of that debilitating condition were prevented each year, we would save billions (with a "b") in health-care costs, not to mention the improved quality of life for the rescued people.
The only definitive downside is an increase in blood clotting which can involve veins or arteries, producing a stroke, if the blood vessels are in the brain. Bad stuff. But you know what? It occurs with only orally taken meds. There are other choices. The estrogens must go through the mouth, and the gut and ultimately the liver to become dangerous clotting agents.