Estrogen

For older women, estrogen was a wonder drug. The hormone not only relieved menopausal symptoms such as hot flashes and mood swings, but also prevented bone loss, heart disease and memory problems. Better yet, it endowed many of those who took it with youth and vigor. At least, that's what everybody thought. Over the past two years, estrogen's reputation has plummeted. Two large-scale clinical studies by the National Institutes of Health were called off early when researchers decided that hormone replacement therapy increased the risk of stroke and heart disease -- the very ailments it was thought to prevent.

All right, ladies, here we go again. About 20 months ago, postmenopausal women taking combined estrogen and progestin therapy panicked at the news that a popular hormone pill, Prempro, carried more risks than benefits overall. Some swore off hormones, causing Prempro sales to fall by 66 percent. Some began cutting back on doses or trying different formulations, such as creams or patches, in hopes of improving the risk-benefit equation. Still others stopped, then shopped around for doctors who would put them back on hormones because of intolerable menopausal symptoms.

The National Institutes of Health ended its major study of hormone replacement therapy yesterday, concluding that while estrogen is a safe short-term treatment for menopause symptoms, it doesn't prevent heart disease and poses a slightly higher risk of stroke. NIH ended the study a year early, asking nearly 11,000 subjects to stop taking their pills. The agency decided that because estrogen doesn't lower heart disease rates, the women should not be exposed to increased stroke hazards. At the same time, scientists and doctors said that estrogen by itself is largely safe for treating menopausal discomfort and said women taking the hormone should continue to do so. "If women are having hot flashes and other symptoms of menopause, they should certainly consider estrogen," said Dr. Barbara Alving, director of NIH's Women's Health Initiative, which oversees the study.

My pharmacist said that there are effective oral medicines for the flu, but they require a prescription. I didn't get a flu shot this year before they ran out. What can you tell me about flu drugs? Your pharmacist was probably referring to prescription antiviral medications. Symmetrel (amantadine) was first approved to treat Parkinson's disease in 1966. It was also found to prevent type A influenza or speed recovery. The Food and Drug Administration approved it for this purpose in 1976, though relatively few doctors prescribed it. A chemical cousin, Flumadine (rimantadine)

Shenna Ross knows she has a high likelihood of developing uterine fibroids. Consider her family history. Ross's grandmother had a hysterectomy at 31 because of uterine fibroids. Her mother had a hysterectomy at 47 for the same reason. Ross, 31, hasn't noticed symptoms yet, but she wants to stay informed in order to avoid having a hysterectomy too. "I need to keep up on the research," says Ross, who lives in Bowie and recently attended a Johns Hopkins Medicine women's health conference.

Novavax Inc., aiming for a piece of the $1.6 billion domestic estrogen-replacement market, has won government approval for a prescription estrogen formulation that is absorbed after being rubbed into the skin like a lotion, the Columbia-based firm announced yesterday. The product, called Estrasorb, received U.S. Food and Drug Administration approval for short-term use by women suffering from the effects of menopause, the company said. In development for nine years, Estrasorb is the first drug developed by Novavax.

ORLANDO, Fla. - Women who take a combination of estrogen and progestin increase their risk of having a heart attack by as much as 81 percent in the first year, and the hormone treatment should be given only to ease severe symptoms of menopause, according to a study released yesterday. The report - which builds on research revealed last year that caused sweeping changes in the way hormones are prescribed - confirmed doubts about the therapy's benefits. Another study released yesterday found that hormones failed to slow clogging of the arteries.

I love a glass of wine with dinner now and again. My doctor has said this is fine and might even reduce my risk of heart disease. What has me concerned, however, is a report that I read about alcohol and breast cancer. Is it true that drinking wine or other alcohol would increase my chance of breast cancer? Alcohol in any form might increase a woman's risk of developing breast cancer. One theory is that alcohol raises levels of estrogen circulating in the blood. Exposure to excess estrogen promotes breast cancer.

Is DHEA a safe way to increase testosterone and improve libido? My wife and I take good care of ourselves, but we do have some health problems that require medications. Our sex life has suffered in the past few years. I take metoprolol for high blood pressure and Lopid for cholesterol. My wife uses progesterone cream and Paxil for mild depression. We've heard that testosterone can really jump-start libido, but we hate the idea of shots. DHEA seems like a natural solution, but we wonder if there are any risks.

When a large study of hormone replacement therapy was abruptly halted last summer because of risks from the drugs, scientists immediately began to reassess all other studies involving the drugs. Another study has been halted, and participants in others have had to give their consent again. Researchers say the ripples from the hormone replacement study will spread for years, making them think carefully about when, if ever, to subject healthy women to estrogen therapy in scientific studies.