What do you think about the National Institutes of Health stopping that big study of hormone replacement therapy? I had a bone density test that showed I've lost more bone than others my age (54). Should I risk other health problems to protect my bones? -- Connie

You're referring, of course, to the recent NIH decision to shut down an arm of its huge Women's Health Initiative, a study of the risks and benefits of hormone replacement therapy (HRT) for post-menopausal women. After five years, investigators found that of every 10,000 women on HRT, a combination of the hormones estrogen and progesterone, there were 8 more cases of breast cancer, 8 more strokes, 7 more heart attacks and 18 blood clots than among 10,000 comparable women who weren't on HRT. The numbers don't sound huge but considering that six million American women are (or were) on HRT, they represent an unacceptable risk compared to the documented benefits: 6 fewer colorectal cancers and 5 fewer hip fractures per 10,000 women on HRT than among untreated women.

I have never believed that all women need hormone replacement after menopause for protection against osteoporosis and menopausal symptoms. In fact, I've often warned women that they must do a careful risk/benefit analysis before starting this therapy.

You can protect against bone loss with weight-bearing exercise and strength training, by making sure you get 1,500 mg of calcium plus 400 IU of vitamin D daily, by not smoking, and by minimizing your intake of caffeine, sodas, and excessive protein. If you've already lost bone, Evista (raloxifene) the first of a new generation of drugs--selective estrogen receptor modifiers, or SERMs--seems to protect against bone loss while actually reducing the risk of breast cancer (it doesn't relieve hot flashes or other menopausal symptoms). Two other relatively new drugs, Actonel and Fosamax, slow bone loss and strengthen bone without any of the risks presented by HRT. I prefer the newer one, Actonel, which has a better side effect profile.

Many women get relief from hot flashes and other menopausal discomforts with black cohosh (Cimifiuga racemosa) plus 800 IUs of vitamin E daily. Two to three daily servings of whole soy foods (tofu, tempeh, edamame, and soy milk) will give you some safe plant estrogen (phytoestrogens) that may help relieve symptoms.

Dr. Andrew Weil

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