Estrogen Replacement Therapy overdose?

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ERT OVERDOSE?

Coming under fire for increasing a woman's risk of endometrial and breast cancers, estrogen replacement therapy (ERT) is the topic for menopausal women. Do the benefits of ERT--a reduced risk of osteoporosis and heart disease--outweigh the potential cancer connections? Considering that 80 percent of the 28 million Americans suffering from osteoporosis are women; that 50,000 of them die annually from fracture-related complications; and that one in five women suffers from cardiovascular disease, some would say yes. But according to a recent study out of the University of California San Francisco (UCSF), taking just half of the standard estrogen dose of 0.625 milligrams (mgs.) may prevent osteoporosis and heart disease as effectively as the larger dose, while reducing ERT-related cancer risks.

Tracking 406 menopausal women over a two-year period, the study (Archives of internal Medicine, December 1997) found that daily doses of 1,000 mg. of calcium and just 0.3 mg. of esterified (modified soy) estrogen were enough to significantly preserve bone mineral density and decrease LDL ("bad") cholesterol. "The gold standard has always been 0.625 mg. of Premarin [a commonly used equine estrogen]. We've always been afraid to use less than that. This study clearly shows that you can use a 0.3 mg. dose and still get bone protection," says Joel Evans, M.D., founder of the Stamford and Darien, Conn.-based Center for Women's Health, which combines both conventional and alternative therapies.

The results, however, may apply to more women than just those taking traditional ERT. "This shows us that maybe you can take half the dose of whatever hormone you're on ... and still get the same bone and lipid protection [necessary for heart health]," explains Tori Hudson, N.D., director of A Women's Time Clinic in Portland, Ore.

Hudson, who prescribes such natural menopause therapies as herbs, plant-derived hormones and nutritional supplements to her patients, is encouraged by the apparent lack of side effects reported in the study. There were no statistically significant reports of endometrial hyperplasia (vaginal bleeding), a precursor to endometrial cancer and one of the major concerns of ERT patients. Subjects also did not experience breast tenderness--which bodes well for breast health. While breast cancer risk was not formally evaluated, "Breast tenderness is generally an indication of some stimulation that's occurring because of the estrogen," explains the study's lead researcher, Harry Genant, M.D., director of the Osteoporosis Research Group at UCSF. "To the extent that one has less stimulation of the breast tissue, there would presumably be less impact on breast cancer."

Genant also points out that taking less estrogen may reduce or eliminate the need for progestin, a female hormone often used to combat endometrial cancer in traditional ERT patients. "The minimal side effects on the endometrium ... suggest that elimination or less frequent or lower dose progestin may be possible," he says. And that's good news for the many women who suffer nausea and headaches caused by the hormone.

Some critics, however, believe the study's design fell short by including only women who had been menopausal for fewer than four years. "After five years of menopause, the body adapts to the lower level of estrogen, and the bone resorption returns to the normal state it was prior to menopause," contends John Lee, M.D., author of What Your Doctor May Not Tell You About Menopause (Warner Books, 1996). "I think they are using it at a time of a woman's life when an) estrogen would work."

Genant concedes that longer studies are needed to determine whether reduced estrogen doses have long-term benefits. But his concession is not a sign of pessimism. "Certainly throughout the two years, the benefit was great enough to prevent osteoporosis. And there were significant positive effects on cholesterol and lipids."

At the very least, women now have a basis to discuss lower doses of estrogen with their doctors. This may indeed be a case where less really is more.
What Is Esterified Estrogen?

While decreasing the amount of estrogen prescribed for menopause is of great significance, describing esterified estrogen as "plant based" is potentially misleading. Yes, it is derived from yams and soy. But it is not natural, as its name implies. Esterified estrogen is produced in a lab and altered with synthetic materials--a process that precludes it from being biochemically identical to natural estrogen.

However, even for doctors who don't strongly advocate synthetic estrogen, the use of esterified estrogen is a step in the right direction. Says Joel Evans, M.D., founder of the Stamford and Darien Conn.-based Center for Women's Health; "Even though they had to alter it, at least we started with a product from plants that's equally efficacious [to equine estrogen]. This is an intermediate way to achieve some balance."

PHOTO (COLOR): ESTRERIFIED ESTROGEN? WHAT IS IT?

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By Cristin Marandino

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