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The Hormone Replacement Therapy Controversy

        Health | Menopause

The Hormone Replacement Therapy Controversy (<i>cont'd</i>)

Hormone Replacement Therapy For Quality of Life

Cardiologist Stephen Sinatra, founder of the New England Heart and Longevity Center in Manchester, Conn., agrees. For women who suffer with heart palpitations, mood swings, night sweats, or dryness of tissues (particularly vaginal), HRT can be a godsend.

"If a woman takes HRT it must be for quality of life issues," said Sinatra. "It's important to realize that the stress from these symptoms alone can precipitate coronary disease. It's really a double-edged sword."

But Sinatra stressed, "HRT doesn't give you any coronary protection even though its been touted that way for years. If a woman has been taking HRT for a long time, I'd tell her to go off."

Sinatra does not suggest HRT for women who have had a heart attack because of the risk of recurrent heart problems, or for healthy women who have just entered menopause and have no quality of life issues, family history of heart disease, or cardiac risk factors.

"If you're unsure about HRT, discuss the risks and benefits with your doctor so that you can make the best decision," Sinatra said. "There is no pat answer to this question. Every woman is different. Every woman is unique. In other words, there is no one-size-fits all."

The Hormone Replacement Therapy Alternatives

"I think the women involved with the study did a great service," said Neal Sikka, M.D., who practices emergency medicine in Washington, D.C. "They've helped us put to rest use of this therapy [estrogen/progestin] in further treating women and now pursue some of the alternatives that are available to treat or prevent those diseases that women are at risk for during menopause."

So what are the alternatives?

"There may not be a one-pill answer anymore, but there are definitely other options," said Sikka. "Certainly, diet and exercise help prevent disease, as well as quitting smoking, but there are other estrogen drugs like selective estrogen receptor modulators (SERMs) that can help women with symptoms and have also proven effective in treating osteoporosis. While the long-term safety is unknown, there is a trial going on now," noted Sikka.

Sinatra, a strong proponent of alternative therapies, encourages his patients to include estrogen-based foods like soy, tofu, flax and fish oil into their diets. He also recommends herbs like black cohosh and Dong Quai, panax ginseng and chaste berry which — while no major trials have been conducted — have been shown in Europe and elsewhere to help ease menopausal symptoms.

These herbs, added Sinatra, are also a good alternative for women who suffer from premenstrual syndrome.

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