Osteoporosis (calcium loss from the bones, with fragility and increased liability to fracture) accounts for over 90,000 hip fractures in postmenopausal women every year. In addition to hip fracture, osteoporosis causes pain and disability from softening and collapse of vertebrae (spinal bones), with loss of height and rounding of the back. (See the section of this book that has been devoted to articles on this very serious disease.)
Osteoporosis, according to Geriatrics (37#3:18), is essentially preventable in women after the menopause if, in addition to taking calcium and vitamin D and regular exercise, they are given estrogens to replace the hormones that were produced by their ovaries before the menopause. While none of these measures must be overdone, all of them contribute to skeletal strength. Knowing this, the physician quoted by Geriatrics states that he finds it appalling that we are permitting this “preventable and treatable disease (osteoporosis) to blossom without doing anything about it.”
The reason, of course, is that estrogens have been linked to cancer of the uterus, thereby possibly doing more harm than good. About 10 years ago, when more cases of cancer of the endometrium (lining of the womb) were being detected in menopausal women, it was thought that estrogens might be the cause. Routine estrogen treatment of older women was therefore discontinued. The thought that estrogens might have been responsible was also strengthened when it was noticed that the number of cases of endometrial cancer being detected recently fell coincident in time with reduced estrogen usage.
Giving thought to this matter, Science points out that the apparent increase in endometrial cancer that accompanied the widespread use of estrogen could have been due simply to better cancer detection. Improved cancer-finding may well have temporarily increased the number of cases reported, but after those cases were found, the number reported would naturally decline to the previous level.
The point seems to be well taken. If estrogens were cancer-producing, one would expect endometrial cancer to be most common before the menopause, at a time of life when estrogen concentration in a woman’s body is at its highest. This is not the case. A Mayo Clinic specialist, writing in Geriatrics (37#3:79), notes that estrogen treatment does not increase the risk of heart attack or breast cancer in postmenopausal women. However, the author agrees that estrogen replacement therapy does slightly increase the risk of uterine cancer. Nevertheless, the article points out, if postmenopausal women being treated with estrogens are examined regularly and understand that they must report immediately if they develop vaginal bleeding, the relatively small risk from uterine cancer (which can be caught early and treated by surgery) will be well below that from osteoporotic fractures. It is important to remember that deaths from hip fracture and its complications are five times more common than cancer of the uterus.
One other caution for women taking estrogens: If you are taking estrogens with other ovarian-type hormones in mixtures such as Amen, Curretab, or Provera, you should stop the medication and contact your physician immediately if you develop any swelling or tenderness of the breasts.
With these safeguards, according to Geriatrics, it seems safer for women to take estrogens after the menopause to prevent osteoporosis than to try doing without them.
*156\143\2*
