Dr. Roach: To replace hormones or not
Dear Dr. Roach: I need some guidance on the use of estradiol. I have been taking a low dose (1 mg) for the past 15 years, following a hysterectomy and oophorectomy. My doctor said I needed it to provide the estrogen once provided by my ovaries that he had just removed. At the time I was also suffering from menopause symptoms such as night sweats.
When I asked my new primary care doctor if there was any issue with continuing its usage, he response was that it doesn't matter — the choice is mine to continue or stop the use. A hematologist told me it was the practice 20 years ago to recommend usage, but not anymore. I have no idea what the pros and cons are. I am 72 years old. Fifteen years ago I did have night sweats before I started using estradiol. What do you recommend?
Dear B.G.: In general, younger women tend to have more benefits and fewer risks than older women, so many experts recommend hormone treatment for women with symptoms. Starting estrogen for the hot flashes at night was entirely reasonable at 57, and continuing the hormones as long as you have symptoms is also reasonable, provided you don't have any reason that you shouldn't be taking estrogen, such as a history of heart attack or stroke, or a history of an estrogen-sensitive cancer. Experts used to say that women should be on estrogen for five years, but some women continue to have symptoms of hot flashes even 15 years after menopause. It doesn't sound like you have tried it, but you could go off of the estrogen you are taking to see whether the symptoms are still there.
Estrogen therapy has some definite benefits, such as reduction of fracture risk and a decrease in colon cancer. It has risks as well, such as an increase in blood clots. Some other risks are more complicated. Starting estrogen in women over 60, or more than 10 years after menopause, led to an increase in heart disease. But this harm was not seen in women under 60. Breast cancer was increased in women taking both estrogens and a progestin called medroxyprogesterone. This increase in breast cancer was not seen in women on estrogen alone. (Women who have a uterus should not be on estrogen without a progestin, due to the risk of uterine cancer).
It is disappointing that your new primary care doctor left the choice up to you without talking to you about your individual issues and giving you the information you need to make an informed decision. At your age, there are probably more risks than benefits to estrogen treatment, and I think it's worth a trial off the estradiol. If you aren't having symptoms, I would normally recommend stopping estrogen in a woman in your situation.
Dear Dr. Roach: Recently I read an article that said we are wasting our money buying vitamins because they don't really help us stay healthy. What are your thoughts about that?
Dear Anon.: For most people with a healthy diet, vitamins are probably useless. Many very good studies have examined whether vitamins help prevent disease, but none have been convincingly done so. Whether vitamins can help in people with a poor diet remains debated. Personally, I'd spend the money you would have spent on vitamins on more fruits and vegetables. This time of year, frozen is a cheap and healthy option.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.