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An article from Rebecca J. Hulem, RN, RNP, Certified Menopause Clinician…


You can't live with them and you can't live with out them…or can you?

The National Institute of Health recently announced that the "estrogen-alone" arm of the Women's Health Initiative Study, and its memory sub-study, Women's Health Initiative Memory Study, was ending early. This announcement was made from preliminary findings of the Women's Health Initiative estrogen-alone arm, with an initial scientific paper scheduled for April 2004.

After seven years, reported changes versus placebo using "estrogen" only, were as follows:

  • Estrogen alone did not increase or decrease the risk of coronary heart disease (CHD)
  • Estrogen alone did not increase the risk of breast cancer
  • Estrogen alone did increase the risk of stroke, similar to the findings reported from the WHI estrogen and progestin arm of the study
  • Estrogen alone did decrease risk of hip fracture
  • In the Women's Health Initiative Memory Study (WHIMS), a sub-study of women 65 years of age and older; estrogen alone did increase risk of probable dementia and mild cognitive impairment

What's a Woman to do?

It has always been my belief, as a health care practitioner and as a woman, that the development of coronary heart disease (the number one killer of women over 50) and its complications of a possible stroke, start to develop long before a woman enters menopause. Therefore, it is very important to remind ourselves and our patients that there is no magic pill that will protect us from unhealthy lifestyle choices.

As much as we prefer not to admit it, healthy eating, regular exercise, not smoking, and stress reduction are our best defenses against heart disease and its complications.

The Role of Hormone Therapy

Hormone therapy may be beneficial and safe:

  • For relief of moderate to severe symptoms of menopause that significantly impact the day to day quality of life, such as hot flashes, night sweats, mood changes, sleep disturbances and vaginal discomfort
  • In short term duration of approximately three to five years and when prescribed in the lowest dose possible to bring relief of symptoms

I am sure the discussion of hormones and their role in the health of a woman in menopause is far from over. In conclusion, while estrogen-only therapies are contraindicated, estrogen combined with progestins may offer short-term relief for millions of women suffering with menopausal symptoms.

Rebecca J. Hulem has 28 years experience in the medical community and is the author of Feelin' Hot and contributing author to two additional books. To sign up for her free menopause newsletter or for further information, please refer to her website at


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