
<b>All sex hormones affect the body, including the cardiovascular system, bone metabolism, cognitive function, and the genito-urinary system.</b>

From the endocrine point of view, menopause is considered a deficiency state and estrogen therapy regarded as restoring the pre-menopausal endocrine balance. Estrogen therapy alleviates acute menopausal symptoms and also reduces the risk of cardiovascular disease, osteoporosis and Alzheimer's disease. Cardiovascular protection seems to be the major benefit of oestrogen replacement: it reduces morbidity and mortality from coronary heart disease by approximately 50%. The mechanisms are complex. Estrogen therapy reduces the rate of post-menopausal bone loss, increases bone mineral density (BMD) and decreases fracture rate. Recent evidence suggests that initiation of oestrogen therapy in older women produces larger increases in bone density which might provide a significant protective effect against osteoporosis and fractures.
[HRT is hormone replacement therapy, a choice for women in menopause.  HRT can be estrogen, or estrogen and progestogen.  Note, we are discussing estrogen replacement alone here [for women who have had a hysterectomy] not combined estrogen/progestogen treatment.]
 
The results of epidemiological studies of the effects of estrogens on breast cancer risk are conflicting but recent evidence suggests that the risk is increased in current users after 5 years of use and among older women. Increase in the risk of venous thromboembolism is most significant within the first 12 months of therapy.

HRT or hormone replacement therapy becomes a question for those women who have passed into menopause, whether naturally or surgically. 

<b>1. If the woman has had uterine LMS, or has estrogen or progestogen receptors on the cells of her NONgenital LMS primary, HRT could stimulate tumor growth of recurrence or metastases. 
2. If the woman has LMS, HRT's stimulation of breast and/or uterine tissue might result in promotion of the SECOND primary cancer that some 7.5% of LMS owners will have. So, even if the LMS is not uterine, HRT might be a bad idea. 

Here are some comments from the ACOR LMS LIST: </b>

Helen: This is my first note to the list. I was diagnosed with LMS this spring - the sarcoma was inside a uterine fibroid. I had surgery in March. Also i got differing advice on the whole question of continuing hormone replacement therapy. The gynecological oncologist said it was OK at very low levels, while the sarcoma expert advised against it. Would appreciate any info from those who have time to respond.

Sarah: Helen, my mom finally stopped taking her Premarin after her (4th) surgery in March 2001. Her first tumor was a uterine fibroid in 1992. She felt all along that the estrogen contributed to her tumor growth, although her OB-GYN doctor insisted that it didn't. When she consulted with Dr. Demetri in June he agreed that she was wise to stop the Premarin since her tumors tested positive for estrogen and progesterone receptors. He recommended taking Evista or Tamoxifen. She is still undecided what to do there...I think she's afraid to take anything at this point for fear it will trigger something else.

doctordee: I would and am avoiding hormone replacement of any kind, including Evista, Tamoxifen, phytoestrogens and soy supplements. The question of safety with LMS and these items has not been answered. Also, I read with interest that 7.5% of LMS patients will have a second primary. I don't have uterine LMS either, but I phased out my premarin because I didn't need any encouragement for a second cancer primary in my breast. I now have these very interesting spells when I don't need clothing. 

Penny: A friend of mine who has a very strong cancer family history is reading "Natural Woman, Natural Menopause" I haven't read it, but she says it gives good alternatives to HRT. 

doctordee: To manage your menopause nonhormonally: 
Have your bone density checked regularly. If bone density becomes a problem, Fosamax works well. Have enough sunlight or Vitamin D. Have enough dairy or calcium & magnesium from other sources. Have enough weight bearing exercise. For the coronary part of the hormone replacement: diet management and exercise are again mainstays. K-Y jelly is very good for the dry vagina problem. I used a beta blocker for the irritability... a beta blocker also helps with those interesting spells. Discuss alternatives for your symptoms with your GP, but check with your sarcoma oncologist before taking any additional medication, or herbal or nutritional supplement.  Because of possible help with estrogen deficiency side effects, some LMS patients are considering using Tamoxifen or Raloxifene rather than standard estrogen replacement. Please see section "NOT Tamoxifen" for discussion of both of these agents.   

<b>AntiHormone Therapy and Cognition and Other Side Effects</b>
The incidence of Alzheimer's disease is reduced by 50% in post-menopausal women taking oestrogen replacement. Limited clinical trials of estrogen treatment in women with this disease have documented beneficial effects on cognitive function. Estrogen supplementation has been shown to preserve cognitive function in nonAlzheimer's cases, too. Effective anti-estrogen treatment might result in some cognitive diminution [possibly concentration and memory functions decreasing somewhat]. 

Men also have difficulties with an andropause syndrome.

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