Word: estrogen
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Unfortunately, estrogen works its preventive wonders only if taken for many years -- the longer, the better. To prevent osteoporosis, for instance, a woman must use estrogen continuously for at least seven years, according to recent data from the Framingham study in Boston. Currently, 95% of women on HRT take it for three years or less -- "not long enough to get any positive effects on their bones," says Dr. John Gallagher, an endocrinologist at Creighton University in Omaha, Nebraska...
Similarly, researchers studying estrogen and heart disease see the greatest benefits in long-term use. Estrogen helps keep levels of LDL cholesterol low and HDL cholesterol high, which is one reason pre-menopausal women have a much lower rate of heart disease than their male peers. Without HRT, a woman's risk of a heart attack rises to match that of men within 15 years of menopause. Estrogen also acts directly on blood vessels, causing them to dilate slightly so that blood flow improves, says Dr. Roger Blumenthal of Johns Hopkins Hospital. But these benefits disappear as soon...
Given all this, it seems logical to recommend HRT for postmenopausal women with high cholesterol levels or other warning signs of heart disease. Indeed, Blumenthal considers HRT "a first-line therapy" for such women. Likewise, it is now standard practice to give estrogen to women with a high risk of osteoporosis -- approximately 1 in 3 U.S. women. Gallagher recommends routine bone-density tests to assess bone condition and at least 10 years of estrogen, beginning at menopause, for those with fragile bones...
While such recommendations are based on the best available research, experts, if pressed, will admit that the research is woefully inadequate. Most of the controlled studies on estrogen therapy have been short-term and can shed no light on long-term risks. "I think the currently available data are extrapolated to excess with respect to heart disease," complains cardiologist David Herrington of Bowman Gray School of Medicine in Winston-Salem, North Carolina...
What does emerge from the longer-term data is that prolonged use of estrogen appears to increase the risk of breast cancer and other malignancies. And the longer estrogen is taken, the greater the risks. For instance, a study of 240,000 women sponsored by the American Cancer Society found that those who took estrogen for at least six years had a 40% increased risk of fatal ovarian cancer. For those taking estrogen for 11 or more years, the increase jumped...