What are the options?

Recent findings about the drawbacks to estrogen (ET) and estrogen/progestin therapy (Combined Hormone Therapy - CHT) make it more difficult than ever to make a rational choice.

When menopause is viewed as a deficiency disease or condition, as it is by some medical practitioners, then it follows that some kind of treatment will be viewed as beneficial to all women approaching menopause. If menopause is seen as a natural stage of biological development, however, hormone therapy will be seen as medication useful only for those most seriously affected (that is, those who have had an artificial menopause, those at serious risk of osteoporosis, and those few women who suffer from intolerable hot flashes). Some people feel that drugs were invented to cushion us from discomfort and stress, and that to spurn such relief is silly. Others feel that we swallow too many drugs without thinking of the consequences, and that sound nutrition and other changes in daily routine should be adopted before resorting to drugs. These differing attitudes influence many decisions about hormone therapy.

ET (or CHT) should be prescribed for a woman only after she has had a thorough medical examination, including not only blood pressure, a pelvic exam, and a Pap test, but also measurement of blood lipids, a clinical breast examination (CBE) and mammogram, and, ideally, a bone density scan. Her doctor will usually insist on a checkup in three months, and every six months thereafter. This means that women on ET or CHT are more likely to have regular medical checkups than women not receiving hormones. Because of this consistent surveillance, including endometrial biopsies, Pap tests, and breast exams, if these women do develop signs of a disease, it is more likely to be caught early.