I have friends who rave about what hormone-replacement therapy has done for them. I’m interested but not comfortable discussing the topic with my male doctor.

DEAR READER: As a woman enters menopause, the ovaries decrease production of both estrogen and progesterone. This reduction causes menstruation and fertility to ultimately cease. Common side effects of menopause include hot flashes, vaginal dryness, mood swings and more.

Until several years ago, these symptoms were thought to be best treated with hormone-replacement therapy (HRT). It appeared simple enough. What the body was no longer able to provide could be handled easily by medication. At the time, it was also thought that elevated estrogen levels could ward off osteoporosis and heart disease and improve quality of life. However, a large clinical trial known as the Women’s Health Initiative (WHI) determined that HRT didn’t provide what was expected and, in reality, posed some health risks. As the number of hazards involving HRT grew, physicians became less likely to prescribe hormone therapy.

Estrogen alone has been associated with a slight increase in the number of strokes and some menopausal symptoms. Estrogen/progestin combination therapy has been linked to a greater number of abnormal mammogram reports. Evidence is now showing that the link between increased postmenopausal use of HRT and breast cancer is stronger and more conclusive. Nonetheless, the benefits of short-term therapy outweigh the potential risks one could experience.

All is not negative, however. Estrogen is the most effective treatment known for relief of hot flashes, vaginal dryness, burning and itching. HRT is believed to decrease the risk of colorectal cancer. Studies remain ongoing but are incomplete regarding a reduction in heart disease when estrogen is taken early in the menopause cycle.
Confusion remains. Even my answer to you is negative and positive at the same time. What is known is that HRT does not provide the spectacular benefits once thought possible, but it is believed the risk to a woman taking hormone therapy is quite low.
There are a number of herbal alternatives touted to help with the symptoms of menopause. Red clover, for example, contains a plant estrogen known as coumestrol that presumably stimulates the ovaries. However, there is no scientific evidence that any herbal supplement is effective. All studies have been small and relatively inconclusive. While I don’t believe this supplement will cause any harm, you will likely be better served by getting professional guidance.

Because you feel uncomfortable speaking with your male physician, I recommend you make an appointment with a female gynecologist. Provide your complete medical history and, together, determine whether HRT is right for you. Keep in mind that there are a number of over-the-counter lubricants available. The fact that you want to maintain an interest in sex is positive. Work together with your doctor and your husband.

To provide related information, I am sending you a copy of my Health Report “Menopause.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

I have read many articles lately about the dangers of HRT, both long- and short-term. However, my primary care physician is adamant that the benefits outweigh the dangers and he continues to prescribe them for me. I respect and trust this physician and have been his patient for more than 40 years, but given the fact that my sister had a double mastectomy (of which he has been made aware), I wonder if continued use of the hormone is safe for me.

I would appreciate your thoughts on this matter. Thank you in advance for any comments you may make.

DEAR READER:
I must congratulate you on the research you have done, as you are extremely well informed.

Levels of female hormones can vary before and during menopause and can result in hot flashes and vaginal dryness. HRT is prescribed to lessen or substantially reduce those unwanted symptoms. Therapy should be prescribed in the lowest possible dose for the shortest possible time to accomplish this. On the positive side, I must state that HRT may protect a woman against osteoporosis.

On the down side, however, it can increase the risk of breast cancer, stroke and heart disease. Certain types of HRT present a higher risk and each woman’s personal risk will vary, depending on lifestyle and family history.

You have a sister who underwent double mastectomy. I don’t know of a stronger family tie than that. In my opinion, you have been on HRT far too long. I am sure all symptoms of menopause have passed at this stage. If vaginal dryness is a concern, there are over-the-counter medicines available. If osteoporosis is a concern, add calcium-rich vegetables to your daily diet, or take calcium supplements.

You have a legitimate and legal right to advise your physician you are stopping the medication. Were I you, I would have done so a long time ago. However, giving him the benefit of the doubt, you might get a second opinion from another physician. In this way, you might feel more comfortable in going against his recommendations. If the action causes ill feelings with your long-standing physician, so be it. In my opinion, he’s wrong. He could have taken you off the medication more than 20 years ago, if even for only a trial period. He didn’t.

We are often fearful of angering a physician or someone of authority. What isn’t taken into concern is that you have only one body and, as long as you are in a proper frame of mind (which you certainly appear to be), you have every right to be in complete charge of it. Take a firm stand, advise him of your wishes, and be sure to stick to your guns. Enough is enough.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicines”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.