ERT

Estrogen replacement therapy or ERT is the administration of Estrogen. Estrogen is a female hormone that brings about changes in other organs in the body.

There are pros and cons of taking estrogen. Let us look at some of the long-term problems that occur with the loss of estrogen at menopause. The bones lose calcium and become thin and brittle. This markedly increases the risk of bone fractures. More than 120,000 elderly women fracture their hips each year and about 15% will die from complications of the hip fracture. The process in which the bones become weak and brittle is called osteoporosis. Collapse of the vertebrae in elderly women can occur because of the thin, weak bones. This is responsible for the loss of height as well as the "stooped-over" appearance known as a "Dowager's hump." Much of the bone loss occurs in the first five to ten years after menopause.

Estrogen replacement therapy stops this rapid bone loss and reduces hip fractures by 25% and spine fractures by about 50%. Unfortunately the process of osteoporosis is not reversible with estrogen replacement therapy. That makes it important to start hormones early after going through "the change" before the process has already resulted in weak bones. Preliminary studies suggest that estrogen replacement therapy may reduce the risk of Alzheimer's disease by up to 40%.

Another long-term problem is the change in cholesterol that occurs with the loss of hormones. The total cholesterol will increase and the good cholesterol, which is called the high density lipoprotein (HDL) cholesterol will decrease. Both of these changes result in a higher likelihood of developing coronary artery disease and subsequently having a heart attack. Estrogen replacement therapy prevents these changes and will reduce the risk of dying from a heart attack by about 35%. This is really the most significant advantage to taking hormones after going through menopause.

Unfortunately there are some potential risks from taking Estrogen. Taking estrogen (Premarin) without progestin (Provera) will increase the risk of endometrial cancer by up to eight fold. This is why we recommend taking progestin with the estrogen. Studies have shown that the combination of Premarin and Provera does not result in an increased risk of endometrial cancer. In women who have had a hysterectomy, it is not necessary to take Provera since they do not have a uterus and therefore are not susceptible to endometrial cancer. The addition of progestin to the estrogen will slightly decrease the beneficial effect that estrogen has on lowering cholesterol.
Another risk of taking estrogen is the increased chance of developing breast cancer. There is a lot of disagreement as to whether there is truly an increased risk of breast cancer, but a general consensus is that the risk is increased by about 25% if estrogen is taken for ten to twenty years.

As one can see, there are risks as well as benefits from taking estrogen replacement therapy. Several studies have actually looked at the life expectancy in women taking estrogen versus those that don't take estrogen. In about all situations, the life expectancy is increased if you take estrogen. This is mainly because of the lower risk of heart attacks when you take estrogen. The prevention of osteoporosis can potentially save lives. One study showed that taking estrogen after menopause was associated with an increased life expectancy of up to 2.3 years. Heart attacks are the leading cause of death overall in females. The annual death rate from heart disease in females in the United States is 359,000. Anything that will reduce deaths from heart attacks by 35% will save a lot of lives.
On the other hand if you have a markedly positive family history of breast cancer then the decision whether or not to take estrogen becomes more difficult.