These are the thoughts of a cantankerous ol' gynecologist who remembers when things were a little different. I try to find a little humor in my life and the people I meet along the way. Come meet the characters in my world.

Friday, September 2, 2011

Granny, Keep Taking Those Hormones!

Estrogen, Menopause and Hip Fracture

There’s a lot of controversy about hormone therapy in women after menopause.  The official position of ACOG (my professional organization) is that a woman should take estrogen at the lowest dose needed for symptoms and for the shortest length of time necessary to keep those symptoms away.

Personally, I have symptoms any time I try to stop the hormones.  So, unless you want me to be a divorced woman whose kids won’t speak to her, I will just continue to take them.

I was doing some continuing education yesterday.  What?  Doctors actually try to keep up in their fields?   Yes, we find it is important to know what research other doctors are doing.  Many states require a number of hours to maintain our license. 

I read a wonderful summary of an article that was written by Dr. Roksana Karim, from USC, Los Angeles, and colleagues which was reported online in Menopause.  The study was done through Kaiser in southern California.  Dr. Karim wanted to know what the risk of hip fracture was for a woman if she discontinued her hormones after menopause.  This is used as an indicator of osteoporosis.  A statement is also made that hip fracture has a 25% case fatality rate. 

These doctors followed nearly 81,000 postmenopausal women for over 6 years.  Some stayed on the hormones, some stopped.  The longer they were off the hormones, the more they had hip fractures.  They first noticed a significant difference at 24 months.  The risk did not change if the women took bisphosphonate medications that are supposed to prevent osteoporosis.  The overall increase in risk was 55%. 

So, stopping estrogen after menopause increases your risk of hip fracture.  This also implies that you are losing bone elsewhere.  My Grandmother had issues with her jaw and lost all her teeth.  My Mom lost about 4 inches in height before she died.  This was from osteoporosis in her spine.  My Dad had some of the same issues with his spine. 

Stop hormones?  Not me!  I’m going to keep taking calcium and Vitamin D, too.

You learn something new every day.

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