However, NOW many perimenopausal women considering HRT are wary of it and thus avoiding it .
The WHI study showed that there were (1).More breast cancer in women taking HRT - 8 more cases in 10,000 women years of intake in the combined Estrogen/progesterone study after 5.2 yrs. (2). More strokes & Coronary Heart Disease.
The study is flawed in several ways.
1). I personally don't think HRT causes new breast cancer. I believe it causes existing breast cancer to grow so they were detected faster. Hence the 8 more cases per 10,000 women years in the treatment arm (people taking HRT) vs those taking placebo after 5.2 yrs.
Cancer takes years to form, i.e 10 years from mutation of genes to dysplasia of cells, to forming enough cancer mass to reach detectable limits, i.e carcinoma-in-situ. (In the study there was no increase in initial cancer or carcinoma-in-situ).
Cancer starts with initial transformation of cells - turning "on" the oncogenes - then estrogen adds to the progression of existing cancer cells to grow).
Ask any gynecologist, and he will tell you that the mortality (death) from breast cancer is lower in people on HRT than those not taking HRT. It is because they are more followed up more closely and if detected appropriate treatment is sought.
2).The study's average age was 63.6 y.old. No gynecologist would in the right mind, start a woman on HRT at that age. It is women age 48-52 that I would recommend HRT. It is in the first five years of menopause that you lose 30% of your bone density. This study was designed by Epidemiologist & Cardiologists, not Gynecologists)
3).There was an increase incidence of stroke & CHD in the group taking HRT. But after 5 years, it was the other way round. Women on HRT had lower incidences. I believe this is due to the initial increase in thromboembolic (clots) events in the initial 12 month with any hormones but more than offsetted by the lipid-lowering effect of estrogen later.
With or without HRT the fact is that prior to menopause, Coronary Heart Disease (CHD) in women is 4 times less compared to men. But in a few years after menopause it approaches to a similar rate as men.
What I would do:
1).Weight bearing exercise
2).HRT for perimenopausal period up to age 52-53, then switch to Fosamax or Evista
Natural products (Black Cohosh, Red Clover & Soy) are all supposedly for "acute" menopausal symptoms such as sweating & hot flushes, and NOT for preventing osteoporosis. Even then all the studies are 6-12 weeks and fare no better than placebo (except for 2 black cohosh studies using outdated parameters).
3)Adequate protein intake - no need to take overpriced collagen products - as collagen is digested into amino acids in the stomach. Just eat enough proteins.
4). If you are eating enough calcium, supplements help little. The needed daily dose is 1,200mg. Yes, some may argue that absorption in the elderly gut may not be as good etc. But studies have shown that calcium supplementation alone is futile in retarding bone loss in the absence of HRT.
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