but on the other hand
How reasonable is women's anxiety about the possible harm of estrogen replacement therapy? Yes, she has negative sides. This is especially true of increasing the risk of developing breast cancer. “I am terribly afraid of breast cancer,” admits Lucinda Mikulski, a 49-year-old teacher. My mother's sister died from him, and I saw her suffer. Although not all physicians are of the opinion that estrogen increases the risk of developing breast cancer, I abstain, just in case. At least I know that there are other ways to reduce the risk of heart disease and osteoporosis. But I feel completely defenseless when it comes to preventing breast cancer. ”
Indeed, in a number of previous studies, there was a link between breast cancer and estrogen replacement therapy. But these studies were performed at a time when much larger doses than estrogen were used. Doctors know that estrogen replacement therapy has the same effect in half the dose. A recent analysis of a study performed to identify the relationship between estrogen replacement therapy and breast cancer showed that for a woman who takes 0.625 mg of estrogen per day is the most frequently prescribed dose, the risk of getting breast cancer is no higher than for those who do not take estrogen. Moreover, the researchers say, with such a dose, there is no reason to believe that prolonged treatment with estrogen increases the risk. This study, however, leaves open the question of whether the risk of developing breast cancer has increased for those who have taken higher doses in the past (1.25 mg per day). Nevertheless, experts insist that the risk is very small.
Unfortunately, this cannot be said about the role that, irrespective of the dose, estrogen can play in the development of other types of cancer.
Studies have shown that if you take only one estrogen for more than two years, the likelihood of developing endometrial cancer (cancer of the lining of the uterus) increases significantly. But doctors have found that prescribing smaller doses of estrogen in combination with progestin removes this danger. According to the results of observations, endometrial cancer in women who took combined hormones, was less common than in those who did not use hormones.
There is a contradiction here. Researchers have still not fully understood what impact a progestin can have on the risk of breast cancer and whether it interferes with the beneficial effects of estrogen on bone tissue and its role in improving heart activity. “We know that a progestin taken along with estrogen can have a detrimental effect on blood cholesterol, lowering the amount of“ good ”cholesterol (with high density lipoproteins) and raising“ bad ”cholesterol, says Donna Schup, MD, associate professor with Department of Obstetrics and Gynecology from the University of Southern California in Los Angeles. Estrogen itself has a beneficial effect on cholesterol. ”
A long-term clinical checkup, which is currently under way under a program called “Postmenopausal effects of estrogen and progestin”, can provide answers to these questions. Researchers supported by the National Heart, Lung, and Blood Institute evaluate the effects of hormone replacement therapy on four major cardiac indicators of cholesterol with high density lipoproteins, insulin, blood pressure, and fibrinogen (coagulation factor), as well as bone mass and changes in the mammary glands and uterus. They hope to find out which treatment regimen will provide the greatest effect and least risk.
In the meantime, the study has given encouraging results, the authors of which evaluated the effect of a combination of estrogen and progestin in small doses on the condition of women in menopause with continuous use of hormonal drugs. Researchers at the University of Arizona in Tucson, Center for Health Sciences, found that a combination of 0.625 mg of estrogen and 2.5 or 5 mg of progestin per day significantly improved the condition of women with pronounced menopause and protected the endometrium of the uterus, while maintaining a beneficial effect on cholesterol levels. blood, which estrogen taken without progestin is known to reduce. Moreover, the researchers note, the number of bleeding cases similar to menses, which were often observed at higher doses of progestin, has noticeably decreased.
Dr. Schup is also experimenting with a new way of introducing progestin, which, apparently, will get rid of unpleasant and unsafe side effects. She observed a group of women who received progestin from special devices introduced into the uterus (IUD). “When using IUD, progestin only gets into the uterus, the only place where it is needed, and the side effects that are common for oral administration of progestin, is not observed,” she says. Dr. Schup hopes that a device will be created in the future, which can be called a progestin uterine implant, which can effectively deliver progestin for five to ten years and will be made of a material that has the ability to dissolve.