Consider alternative therapies to long-term estrogen use

Chronic oral estrogen therapy provides no overall benefit when used to prevent chronic disease, according to results of studies conducted by the Women’s Health Initiative.

  • Risks outweigh benefits in the treatment of osteoporosis. For every 10,000 women treated with estrogen in one year, six fractures were prevented, but 12 additional stroke cases were reported (1).
  • Dementia, lack of cardioprotective benefits and an increased risk of breast and endometrial cancers in patients taking estrogen for longer than five years supports the discontinuation of estrogen in these individuals. (1)

Short-term use of estrogen for relief of significant vasomotor symptoms still is considered an effective option due to the low absolute risk of cardiovascular disease and breast cancer, but is recommended only for patients who have entered menopause within the past decade. Therefore, women age 65 and older who are on estrogen therapy should be re-evaluated for continued need.

The FDA recommends that estrogen – in any dosage form, and used with or without progestin – is prescribed at the lowest effective dose for the shortest duration consistent with treatment goals. It is unknown at what dose there may be a decrease in risk of serious side effects; therefore, regular evaluation for continuing therapy is recommended. (2)

Alternative treatment recommendations include:

  • For vasomotor symptoms: nondrug therapies, SSRIs, gabapentin and venlafaxine
  • For atrophic vaginitis: Estradiol and Premarin vaginal creams that may alleviate symptoms, with less risk
  • For the prevention and treatment of osteoporosis: weight-bearing exercise; adequate calcium and vitamin D intake; and, when indicated, pharmacologic therapy with bisphosphonates, raloxifene or other agents (e.g., calcitonin or Forteo®) (3)

Resources

  1. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA. 2002 Jul 17; 288(3):321-333.
  2. Food and Drug Administration. Estrogen and Estrogen with Progestin Therapies for Postmenopausal Women. Accessed on Aug. 22, 2011.
  3. ACCE Guidelines of Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Postmenopausal Osteoporosis. Endocrine Practice. 2011.