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-rel ated macular degeneration, colon cancer, diabetes mellitus, Alzheimer's dis ease, and Parkinson's disease. Coronary artery disease is the most frequent cause of death in women age 50 years and older, yet most women report a fe ar of dying from breast cancer. Current data suggest that women who take so me form of hormone replacement therapy (HRT) after menopause can reduce the ir cardiovascular mortality approximately 50%, yet many stop taking HRT-or never start-because of this fear. Although use of estrogen replacement ther apy and HRT (after a diagnosis of breast cancer) currently is contraindicat ed for at least 5 years by the US Food and Drug Administration, 3 studies h ave found that women who took hormones had no greater incidence of breast c ancer recurrence than the general breast cancer population. Evidence sugges ts HRT has a beneficial effect on the central nervous system, including on neurotransmitter systems within the brain that are implicated in mood disor ders and depression; learning, memory, and Alzheimer's disease; and movemen t disorders such as Parkinson's disease. When women are counseled about the benefits and risks of HRT and alternativ e 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 in fluence how they view menopause and their receptivity to available therapeu tic options.