30 Years on Hormone Replacement

Why are you on biest? You always need to evaluate on a yearly basis the rationale for continuing a medication. Circumstances can change, and the benfits should exceed the risks for your individual situation. Hormones should be used in the lowest doses that achieve the objectives you are using them for, and for only as long as necessary to achieve your goals. Although some books in the past, like “Feminine Forever”, and some proponents of anti-aging therapy propose open-ended prescription of hormones, the general rule is that use for more than five years will increase the incidence of breast cancer. Although estrogen had been thought to prevent heart disease in the past, it does not appear to do so according to the most recent studies. It is not clear that estrogen prevents Alzheimer’s or imporves mental function. If you have osteoporosis or osteopenia, estrogen may be stabilizing yout bone density, and that could be a reason to continue therapy. Many physicians believe biphosphonates such as Fosamax or Boniva are better than estrogen for stabilizing or improving bone density. For most women vasomotor symptoms – hot flashes and night sweats – do not go on indefinitely. But there are certain women who have intractable vasomotor symptoms for years, and some women who feel depressed and have low energy without estrogen supplements. At age 72 most women should have weaned off estrogen, with the possible exception of vaginal estrogen for vaginal symptoms. If you have osteopenia or osteoporosis and/or feel terrible without estrogen, that would justify continuing estrogen provided you knew your chances of getting breast cancer were slightly increased, Estriol is the safest form of estrogen, and biest the next safest if estriol alone is not strong enough to achieve your objectives of therapy.

Mary L. Davenport, M.D.