HORMONE REPLACEMENT THERAPY AND HEALTHY BONES: MONITORING YOUR PROGRESS
Estrogen effectively protects bones for 85 percent of users, especially when used for ten years or more, in particular right around menopause. Since it isn’t enough for some women, you should monitor your progress with the tests, so you will know if you need to add another treatment (see following chapter) or discontinue this one. Studies are under way to determine the effectiveness of combining HRT with the more aggressive treatments described in the next chapter. Given what we know now, I recommended adding one of them if HRT alone is helping you make progress, but not enough progress. (If HRT is doing nothing for you, you might as well discontinue it.) You should have a baseline bone density scan, and repeat it after two years on hormones to gauge your progress. Following your NTX levels will also be helpful. You should see a decrease in the NTX level, and can reasonably expect estrogen to keep your number under 30. Lower NTX levels are always better. If you follow healthy eating and exercise guidelines, that is a goal well within your reach.For women with breast cancer or uterine cancer, or with two close relatives with breast or ovarian cancer, the risks of HRT clearly outweigh the benefits. (Some women with breast cancer can actually be treated with estrogen, but that’s another subject altogether.) Women with abnormal vaginal bleeding shouldn’t use HRT until the cause is discovered, and those who have had problems with blood clots should also be wary, though there’s no proof of increased danger. Anyone with fibrocystic breast disease should be aware that mammograms may be less accurate with that condition, making it difficult to detect breast cancer as early as would be desirable. Uterine fibroids should also make you think twice about taking a drug that can make them grow, or you may wind up needing a hysterectomy you might otherwise avoid.With these few exceptions, HRT is the best traditional medicine has to offer when it comes to maintaining bone density, and all women should consider it seriously as they approach menopause. When talking the decision over with a health care professional, keep your bone health in the front of your mind, along with heart disease and cancer risks, and you’ll be able to achieve a healthy balance. The charts above will help you sort through the many types of hormones available to help with bone density and how they affect a range of other health concerns. The “alternative” hormones covered in the next chapter are included here, too, for the sake of comparison, but the highlighted options are the traditional options this chapter covers. If you learn nothing else from this book, I want you to remember that although we tend to use “HRT” to mean estradiol pills, or estradiol/progestin combinations, there are actually a host of choices, each with its own pluses and minuses, and only you can pick the best one for you. You should have very specific reasons for taking any hormone, and those hormones should be geared at creating balance within your body. There may be things that can create that balance other than hormones, so when you choose hormones, you want to be clear on the point that this is the best option for you. The current trend of making a blanket recommendation for HRT for every woman at menopause is a mistake. For you as an individual, estrogen may not be the best thing. Or maybe it is. The only way to know is to take into account all the details of your own particular situation.*140\228\2*
