Writing Sample: Health Care Book Chapter

From "Women's Hormone Modulation" (chapter in Disease Therapies Protocols, 1999)

Women's hormone modulation is complicated further by a perplexing dilemma regarding estrogen, one of the primary sex hormones. The amount of estrogen naturally produced dwindles as women age, causing a wide range of menopausal miseries. This estrogen decline is a direct cause of hot flashes, depression, vaginal dryness, anxiety and forgetfulness. One solution to this problem is to take one or more synthetic hormones to replace what the body no longer produces.

Estrogen replacement therapy (ERT) remains controversial, largely because approved estrogen drugs have been documented as a cause of cancer. The most conclusive report showed that women taking estrogen and a synthetic form of another primary sex hormone, progesterone, had a 32% to 46% increase in their risk of breast cancer (New England Journal of Medicine, June 15, 1995). These drugs carry long warning labels listing a number of dangerous side effects.

Though estrogen increases the risk of some types of cancer, it also has critical anti-aging benefits, including the prevention of osteoporosis and heart disease. Some physicians do not believe that estrogen causes cancer, and others think that combining estrogen with a synthetic progestin neutralizes the risk. The most recent studies indicate that estrogen does not cause cancer in the short-term, but in women taking estrogen and/or a synthetic progestin for more than 10 years, there appears to be a significantly elevated risk of breast, ovarian and uterine cancer.

In addition to increased cancer risks, women placed on estrogen/progestin regimens have a higher incidence of abnormal blood clot formation, weight gain, gallstones and a variety of premenstrual symptoms.

Despite these unpleasant and sometimes lethal side effects, many women use ERT because of its ability to reduce some of the unwanted effects of menopause, as well as for its anti-aging properties. Some of these properties include enhanced skin smoothness, increased muscle tone, elevated sex drive, enhanced immune function and a generalized feeling of well-being. All of these desirable benefits entice many women to accept the risks that ERT entails.

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