Consequences of estrogen deprivation and the rationale for hormone replacement therapy

Menopause results in a fairly precipitous decline in estrogen levels. This estrogen deprivation is probably associated with a number of consequences, including osteoporosis, tooth loss, cardiovascular disease, stroke, age-related macular degeneration colon cancer, diabetes mellitus, Alzheimer's disease, and Parkinsons's disease. Coronary artery disease is the most frequent cause of death in women age 50 years and older, yet most women report a fear of dying from breast cancer. Current data suggest that women who take some form of hormone replacement therapy (HRT) after menopause can reduce their cardiovascular mortality approximately 50%, yet many stop taking HRT - or never start - because of this fear. Although use of estrogen replacement therapy and HRT (after a diagnosis of breast cancer) currently is contraindicated for at least 5 years by the US Food and Drug Administration, 3 studies have found that women who took hormones had no greater incidence of breast cancer recurrence than the general breast cancer population. Evidence suggest HRT has a beneficial effect on the central nervous system, including on neurotransmitter systems within the brain that are implicated in mood disorders and depression; learning, memory, and Alzheimer's disease; and movement disorders such as Parkinson's disease. When women are counseled about the benefits and risks of HRT and alternative therapies, it may help for physicians to keep in mind that women are more than a sum of their estrogen receptors: their emotions and beliefs will influence how they view menopause and their receptivity to available therapeutic options.