Estrogen Replacement Therapy And Its Alternatives

Since the release of the Women's Health Initiative study in 2002, estrogen based hormone replacement therapy has been severely maligned for its negative effects on uterine and breast cancers. However, the potential risks of estrogen replacement therapy do are outweighed by the benefits for some women; furthermore, newer drugs are being developed that have many of the same beneficial effects on osteoporosis and heart health, but do not carry the same cancer risks as traditional estrogen therapy.

As women near menopause, the level of estrogen in their bodies decreases dramatically. This decrease in estrogen can cause the classic menopausal symptoms, such as hot flashes, hair loss, vaginal dryness, etc... Additionally, the decrease in estrogen can lead to bone loss (osteoporosis). To combat these symptoms and effects, estrogen replacement therapy or a combination of estrogen and progestin therapy can be administered. These therapies are effective at combating the common symptoms of menopause and also have other beneficial effects.

Unfortunately, estrogen and combination hormone replacement therapies have been maligned in recent years after the release of the 2002 Women's Health Initiative study that showed an increased risk of breast cancer and in women who received the combination of estrogen and progestin hormone replacement therapy. Furthermore, in a study of those women using estrogen only, the Women's Health Initiative showed an increased risk of uterine cancer. Nonetheless, the beneficial effects of hormone replacement therapy still outweigh the potential negative effects for some women.

The beneficial effects of estrogen and combination hormone replacement therapy include reduced risk of osteoporosis, protection against cardiovascular disease and delayed effects of Alzheimer's disease. For women who are not at an increased risk for breast cancer or uterine cancer, hormone replacement therapy can therefore still be quite beneficial. However, women who have a history of breast cancer, uterine cancer, blood clots, liver disease, gallbladder disease, migraines and coronary heart disease are not good candidates for traditional estrogen or combination hormone replacement therapy.

As an alternative to traditional hormone replacement therapies, newer drugs called selective estrogen receptor modulators are beginning to be used in medical practices across the country. One such selective estrogen receptor modulator is Raloxifene. Raloxifene has been shown to reduce the risk of osteoporosis and coronary heart disease, while not affecting breast or uterine tissue. Raloxifene works by binding to select estrogen receptors in the body and sending estrogen like signals. However, Raloxifene does not send those signals when attached to estrogen receptors in breast or uterine tissue - so the risk of cancer is not increased. In fact, one study on Raloxifene showed a 59% decrease in the risk of estrogen positive invasive breast cancer in patients taking the drug, as compared to those taking a placebo.

At this time, Raloxifene is only indicated for the prevention of osteoporosis. However, researchers are doing further study on the results that showed the lowered risk of estrogen positive invasive breast cancer, to determine if Raloxifene could be used as a preventative. For now, Raloxifene is being used in women who are past menopause and are worried about bone loss. In the future, however, we may see Raloxifene as an alternative to Tamoxifen.

If you are a menopausal woman concerned about osteoporosis, see your doctor to find out if estrogen replacement therapy or a drug like Raloxifene is right for you. With this information and your doctor's advice, you should be able to make an informed decision about what's right for your body.

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