The severe side effects of estrogen replacement and how they are treated.
We are continuing our discussion of the side effects of estrogen replacement. Last week we spoke of mild and moderate side effects of estrogen replacement. This week we want to address the more severe side effects and the recommended treatments for those.
Brett Newcomb and I are discussing why uterine cancer is a side effect that many think of immediately when they think of estrogen replacement. Uterine cancer was very prevalent in the sixties and early seventies when women were given estrogen replacement alone, even if they had a uterus. Women were given this hormone, without really having their uterus. No one intervened about this until or unless the women suffered a severe amount of bleeding. At that point, biopsies were done and cancer was found. This was after years of taking what was referred to as “unopposed estrogen.”
We now know that at least two events skewed the cancer reporting. One was that pre-existing polyps were not found and treated before administering estrogen. The other is that progestin was not given along with the estrogen in order to regulate the thickness of the lining of the uterus.
These are standard treatments today, and the uterine cancer rates have dropped dramatically.
The second big risk for estrogen replacement is called “DVT” or “deep venous thrombosis,” the creation of blood clots that can break loose and go to the heart or lung. These are very dangerous. We now know to test for genetic markers that identify women at risk for these issues. Women who are at risk need to consult with their doctors whether or not they can or should take estrogen along with aspirin or folic acid. Sometimes the decision is not to. In those cases we only administer testosterone replacement and do not replace the estrogen.
We have also learned that non-oral estrogen is the safest and best way to administer estrogen for replacement therapy. One of the reasons we prefer non-oral estrogen is that it decreases the risk of developing fibroids. Sometimes we recommend surgery to remove the fibroids before we administer estrogen replacement. These are decisions a woman makes with her physician after they obtain the necessary information.
Listen to our podcast and learn about these serious side effects of estrogen replacement, along with other questions such as hysterectomies and liver tumors. There are many questions that women must ask, but generally, replacement of estrogen is worth the risks because cost savings and the improvement in general health.