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Hormone Replacement Therapy

There are approximately 50 million women in the United States over the age of 50.

If every one of these 50 million women were to take estrogen replacement pills for 30 years, drug companies would sell them drugs for a total of 1.5 billion woman-years. Never before has a drug regimen been proposed on such a scale, in which mostly healthy women are targeted for perpetual drug consumption.

An estimated 10 million U.S. women take Premarin, an estrogen approved to alleviate the symptoms of menopause such as hot flashes, and for the prevention of osteoporosis. The drug's maker, Wyeth-Ayerst Laboratories, a subsidiary of the American Home Products Corporation, says that estrogen is the best-selling prescription drug in the U.S.

The main selling point for hormone replacement therapy has been the claim that it significantly reduces the risk of heart disease. However, a federal study publicized in April, 2000, indicated that far from protecting the heart, the therapy may have instead put the women at a slightly higher risk of heart attacks, strokes and lung clots. The study was the first large-scale controlled clinical trial focused on whether the therapy prevents heart disease in healthy post-menopausal women.

According to a 1997 report from the Nurses' Health Study, for women who smoked, were overweight, had high blood pressure, high cholesterol levels, or other known risk factors for heart disease, hormones slashed their elevated risk of mortality by more than half.

However, for women who were healthy and in good shape, the study found that hormone use showed no statistical benefit in reducing mortality. Moreover, for any subgroup, the survival benefits of hormone replacement therapy declined with duration of use. The rate of death from breast cancer, which some studies have indicated is elevated by hormone replacement therapy, begins canceling out the purported and now highly questionable benefits.

Hormone replacement therapy reputedly inhibits the dissolution of bone, maintains the pliancy of the bladder's sphincter, and prevents the vaginal wall from getting thin and dry, which can make sexual intercourse without added lubricant painful. Some studies indicate that estrogen therapy may reduce the risk of Alzheimer's disease by about 50 percent.

The U.S. leads the world in giving its postmenopausal citizens hormone replacement therapy. (The U.S. also leads the world in the rate of hysterectomies.) Forty six percent of postmenopausal women in the U.S. take or have taken hormone replacement.

British, Australian, and Scandinavian women take hormone replacement at rates of around 30 percent. The rate among Japanese women is about six percent.

In the U.S., more formally educated women are likelier to take the hormones, and to agree with the statement, "the benefits outweigh the risks." In Norway, the more educated the woman is, the more likely she is to reject hormone therapy.

Several studies have indicated that one of the biggest reasons that many women reject hormone replacement therapy is that they have positive feelings about menopause, and view it as a natural process.

(sources: The New York Times, and Woman by Natalie Angier)


 
 
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