Dr. Roach: Balance risk against benefit with estrogen cream

Keith Roach
To Your Health

Dear Dr. Roach: In a recent column, you addressed the costs of vaginal Premarin but did not mention the risks associated with stroke and dementia. Do you consider these risks to be of importance? I am wary of using Premarin, although I suffer from vaginal atrophy.

— J.S.B.

Dear J.S.B.: Hormone replacement, given orally or by patch, increases risk of blood clotting. This can certainly lead to increased risk of stroke, and pulmonary embolism, which is a blood clot in the lungs.

The dementia association is more complex. Estrogen appears to reduce dementia and heart disease when started early, right at menopause, but it increases dementia and heart attack risk when started 10 years or more after menopause. On the other hand, estrogen reduces colon cancer risk but increases breast cancer risk (when taken with a common progesterone).

However, all of these risks are from systemic estrogen. Low-dose vaginal estrogen, as treatment for vaginal atrophy, probably has very little or no systemic risks. That said, a woman with a history of an estrogen-sensitive cancer should discuss her risk with her oncologist. Women with a history of blood clots should likewise discuss their personal risk, and for all women, risks must be balanced against benefits.

I received quite a bit of advice from women who use estrogen cream. I wanted to pass on advice from one woman whose physician sent her to a compounding pharmacy that made estradiol cream at a small fraction of the cost of the brand name. Another woman found that she did not need the entire dispenser full of medication to relieve symptoms. As always, I appreciate the helpful advice from readers actually living through the issues I write about and pass on the information when I can.

Several readers wrote about what they describe as inhumane conditions of horses used in the manufacture of Premarin (the name comes from PREgnant MARe urINe). I recommend estradiol as first choice from a medical perspective, as it is the bioidentical human hormone. Synthetic estradiol is made with soy or yams as a starting material, which I confirmed from the manufacturer.

Dear Dr. Roach: Are deodorants containing aluminum safe to use? The brands that do not contain aluminum are much less effective. I am concerned about absorbing the aluminum from the deodorant and its effect on the brain.

— D.M.

Dear D.M.: That’s a myth. The amount of aluminum in antiperspirants is negligible. Deodorants that aren’t also antiperspirants don’t contain aluminum. The aluminum mechanically blocks the sweat glands in the armpit, and 99.99% of it is not absorbed into the body. Long-term studies of people taking aluminum-based antacid (which is also poorly absorbed) have shown no increased risk of dementia. The body has several ways of removing the small amounts of aluminum we absorb, mostly via the kidneys. Aluminum toxicity IS a potential problem for people with kidney disease on dialysis, but the small amounts of aluminum in antiperspirants is too small to worry about even in those cases.

Readers may email questions to ToYourGoodHealth@med.cornell.edu