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The hormone therapy dilemma: Misery without it, risks with it

...It's one of several such medications prescribed to relieve the symptoms of perimenopause, which can begin as early as a woman's mid-30s, and menopause, the permanent cessation of menstrual periods that usually occurs sometime between the age of 45 and 54.

As a woman approaches menopause, her ovaries begin to shrink.

Levels of estrogen and progesterone, the two female hormones produced in the ovaries, begin a corresponding drop.

For about 20 percent of menopausal women, "everything in life goes sour," says physician Mitchell Harman, director of the non-profit Kronos Longevity Research Institute in Phoenix.

"They have trouble with sleep, with memory loss, with libido," he says.

"Some of this goes away if they wait long enough, but the mental disorganization can be especially troubling.

They think they have Alzheimer's disease or are going crazy.

These are real quality-of-life issues." To treat the symptoms, doctors commonly prescribe hormone therapy: estrogen alone or in combination with progesterone or a similar synthetic progestin.

Progestins protect the uterus from cancer; women who have had a hysterectomy can take estrogen alone.

Until recently, the therapy held promise beyond symptom relief for middle-aged women, whose risk for heart disease and osteoporosis rises after menopause.

Many scientists believed that the increased risks were linked to the drop in ovary-produced estrogen.

Replacing the hormone, the...

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