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Dr: Zorba Paster: Debate continues over hormone replacement therapy

Back in the 1990s, we invited every woman of menopause age to take Hormone Replacement Therapy (HRT), as it gave promise of a longer, sweeter life.

We thought there would be fewer heart attacks (we were wrong), fewer blood clots (wrong again) and fewer strokes (strike three, we’re out).

The monumental Heart and Estrogen/Progestin Replacement Study (HERS), showed that when we thought we were helping, we were actually hurting. This resulted in a dramatic drop in the use of estrogen-containing products.

But now the question is how to help a woman who has intolerable menopause symptoms. A so-called “natural” cure using the herb black cohosh has been a bust – well-controlled scientific studies have not shown it’s worthwhile, even though the supplement producers disagree. Boo-hoo to them.

Antidepressants offer some relief, but it’s minimal. When I was a med student, believe it or not, Valium was considered to be a viable treatment. The dose I was taught was 10 mg of Valium four times daily – that’s enough to keep a race horse from complaining.

The fact of the matter is HRT still has its place. For some women it might be used for just a few months and for others a couple of years. It has a risk, but the risk is like being on the birth-control pill.

If you don’t smoke, if you exercise, eat a Mediterranean diet, keep your blood pressure in check and your cholesterol under control, the risk from HRT has been minimized. In other words, think of the heart attack risk as a sum of all the risk factors and not just HRT.

With that in mind, a recent study published by the Journal of the American Medical Association, in JAMA Internal Medicine, is very exciting.

In Seattle, 400 menopausal women took one of two estrogen compounds. One was Premarin – the first, most common and oldest estrogen compound, first introduced in 1942.

This compound, distilled from the urine of pregnant mares, is the gold standard. My mom used it back in the 1960s. She called it her “anti-sweat pill.” Go, mom.

The study compared Premarin to another estrogen formulation called estradiol, most commonly used in birth-control pills. The data found that both sets of women were more likely to get blood clots than women not using estrogen compounds, but the women on estradiol got fewer.

So what’s a woman to do?

My spin: HRT has a risk, no doubt. You can reduce the risk with good living and addressing other health-risk factors.

Reducing risk doesn’t mean eliminating risk. Every time I get in my car, I take a risk. If I buckle up, drive defensively and don’t speed, I’ll reduce that risk.

Every time I turn my head to adjust the car radio, I take a small risk that I might crash. But I’m willing to take that risk because I love public radio and the car is where I listen to it the most.

Managing risk is part of life. As with so much in medicine, it means a good, long, one-on-one conversation with your doctor, physician assistant or nurse practitioner so you can make the right choice for you.

But if you say yes to HRT, toss the Premarin and go with the estradiol.

Dr. Zorba Paster is a family physician, university professor, author and broadcast journalist. He also hosts a radio program at 3 p.m. Saturdays on WBFO-FM 88.7.