Prime Time - Jane Fonda [99]
The problem, as many experts have explained it to me, was that the study was misleading because the women participants were recruited from Medicare rolls, their average age was from sixty-three to seventy-nine, many were obese or smokers or both, and some two-thirds of them had never been on hormones before and thus had been estrogen-deprived for many years leading up to the study.
It is my understanding that the optimum time to begin HT is at menopause. Dr. Michelle Warren, medical director at the Center for Menopause, Hormonal Disorders, and Women’s Health at Columbia University Medical Center, told me, “If you start HT at menopause and continue with it, there is protection against bone loss and vaginal atrophy and probably some protection against heart disease and other problems that can occur before, during, and after menopause. Some recent data also shows that the death rate is decreased in women taking hormones, and that the increase in heart attacks is not significant. Recently, they went back and saw that for the women who had been on estrogen alone, the hormones were really protecting the heart. Additionally, the study showed that in the women who were given estrogen alone as opposed to estrogen together with progesterone, there was no increase of breast cancer after almost seven years. This fact got little attention. The absolute relative risk is very small—.8 per thousand per year. I don’t think the hormones are causing breast cancer. They may be fueling the growth of some atypical cells that are present in the breast, but the risk is very, very tiny. The estrogen-responsive cancers are very responsive to treatment, and after you stop the estrogen, the risk of cancer goes away.”
In their book Successful Aging, Drs. John W. Rowe and Robert L. Kahn cite the Nurses’ Health Study, which followed fifty-nine thousand women for sixteen years. They note, “The consensus of this research is that postmenopausal hormone replacement re-duces the risk of heart disease an average of 44 percent, and increases life expectancy by 3 years—a dramatic effect.”3 The study goes on to say, “For women with one risk factor for heart disease (such as smoking, hypertension, diabetes, or a sedentary lifestyle), the benefits of hormone replacement outweigh the risks. This holds true even for women with a first-degree relative (mother or sister) with breast cancer. However, the equation shifts for women with no risk for heart disease and two first-degree relatives with breast cancer. For these women, HT carries more risk than benefits.”4
According to its proponents, HT helps keep the brain healthy by preventing shrinkage, and it can lead to more brain-cell volume. HT can actually help the speed of brain functions, and studies have shown that when begun early in menopause, HT may be able to delay dementia symptoms. Additionally, say these advocates, estrogen helps preserve bone and works with other hormones to increase bone mass. The hormone also helps bones absorb calcium, but only as long as you use it: When you stop taking estrogen, the bone loss resumes. The Mayo Clinic does not recommend taking estrogen just to prevent bone loss, however, as the risks outweigh the benefits in many women.
Postmenopausal women who are not on HT and who are at heightened risk of developing osteoporosis are those who have suffered food addictions such as bulimia and anorexia, smokers, very slight women, those who have been particularly sedentary, those who have suffered from intestinal tract problems (which impede the absorption of calcium), and those who have experienced frequent fractures. These women should consider being screened for osteoporosis. The most up-to-date screening method is called a dual energy X‑ray absorptiometry test (DEXA). It is rather expensive and is currently covered