This article highlights one of the quandaries for women of our time. The news about estrogen has been very confusing. Until ‘02 before the WHI was prematurely halted we were told that we needed to take estrogen to protect our hearts but since the WHI the news on estrogen has been very confusing.
I applaud the author of this NY Times article for really getting into the essence of the WHI study and summarizing the most salient and controversial features. It is obviously that much more important to her as a woman who “needs” estrogen herself.
The author’s story is poignant. She feels “crazy” when she is not on estrogen. Crazy to the point of driving into tractor-trailers by accident or stabbing loved ones because of black moods that seem to come from out of nowhere. These are not small symptoms. These are the type of symptoms that women come to my office complaining of every day. They want to kill everyone and hate everything including themselves most of all. Almost all of the women I see lament that they just wish they could feel like their old selves. They feel that they lost something along the way and almost universally complain of these crazy mood swings, hot flushes, inability to sleep, no energy, no memory and no sex drive.
Just like the author in the story these patients respond extremely well to hormone replacement therapy. Most of these women patients have seen multiple doctors for their symptoms and have been offered multiple medications from birth control pills to anti-depressants with no improvement in their symptoms. Finally when they go on hormones they are so happy and thankful that they are less concerned with the risk and happy they have their lives back.
About the risk: the author summed it up very well in her article by saying that the only things that we clearly learned from the WHI is that if you are a woman who has been menopausal for 10 yrs you should not start Prempro (the estrogen from mare’s urine combined with MPA – an artificial substitution for progesterone). The author points out that the WHI study did not study hormones that are the same as those in a woman’s body like estradiol or progesterone. The “timing” hypothesis regarding how long a woman has been menopausal is an interesting one that we are all following closely and awaiting more data about. For now we do have a lot of questions but the preliminary data would suggest that when hormones that are the same as those in the body are used in women who are within 10 years of menopause that we can expect an improvement in the risk of heart disease and Alzheimer’s disease, improvements in mood, energy, memory and libido and no discernible increased risk of breast cancer as long as artificial progesterone substitutes are avoided. This is what the best data we have right now is showing us and my patients are doing extremely well on hormones and have no desire to give them up anytime soon; we will be watching the outcomes of these studies to determine if there are ways to improve our practice of hormone therapy in the future.