ESTROGEN

A clear explanation of the particular medical school of thought that says every menopausal woman must be on hormone replacement therapy—but one that will turn many women off. Romoff (associate director of obstetrics and gynecology at New York’s Lenox Hill Hospital) is firmly convinced that the benefits of estrogen replacement far outweigh the possible dangers. Among those benefits: protection from heart disease first and foremost, but also reduced risk of Alzheimer’s disease, tooth loss, sleep disturbances, sexual difficulties, and such annoyances as hot flashes. The downside, which Romoff feels has been blown totally out of proportion, is a possible increase in breast cancer risk. His reading of the evidence is that “estrogen use causes no increase in breast cancer in the first five years of use” and only a possible increase after that. Romoff appears to be out of patience with women who have misgivings about taking estrogen; aside from what he sees as unrealistic fears about breast cancer, they should also get over their dislike of such side effects as breast tenderness and occasional bleeding—and he has no time for those who feel they just “don’t need” hormone replacement at all. A clearly laid out, strongly argued case, then, but one that seems more and more out of touch with women’s current concerns and thoughts about approaching menopause.