- In recent studies, estrogens or combined estrogen-progestins given to postmenopausal women did not prevent coronary heart disease or heart attacks. Indeed, there appears to be a small (29 percent) increase in risk during the first five years of hormone treatment.

- The drugs increased the risk of breast cancer to a modest extent.

- The drugs increased the risk of strokes in the first five years after starting treatment.

- A recent study in the Archives of Internal Medicine showed no overall increased risk of stroke, but did find an increase during the first six months of use. It may well be that, after the early period of use, there is no further stroke risk. Additionally, the risk of stroke appears dose related. Women using the conventional dosage of estrogen (0.625 milligrams) are at less risk than those using higher dosage and there may be no increased risk at all for those using 0.3 milligrams. So, if you use estrogens, the lower the dose, the better. Still, at present, women should assume that postmenopausal hormone treatment does increase somewhat the risk of stroke, especially during the first few years of use.

- It is quite possible (indeed, probable) that healthy women without coronary heart disease taking estrogens or estrogens-progestins will show a small increase in risk of heart attack in the first four to five years of use, but a significant decrease thereafter. That possibility is now being tested.

- There is clear evidence estrogens increase bone strength and reduce the risk of osteoporosis and fractures. That is an important benefit.

- There is some evidence that estrogens or estrogens plus progestins reduce the risk of bowel cancer. That would be an important benefit, but, in the judgement of Healthful Life, it is not yet adequately documented.

- Left out of recent risk:benefit analyses is the real (but not yet proved) possibility that estrogens can reduce the risk of developing Alzheimer Disease by as much as 50 percent. That would be a huge benefit. In the Archives of Internal Medicine for September 23, 2002, Dr Howard M. Fillit of the Institute for the Study of Aging in New York City reviews the biologic evidence indicating that such a benefit from estrogens is plausible. Then, he reviews the clinical evidence. About one-half the studies show a reduction in risk of developing Alzheimer’s, half do not; but, the better designed studies (called prospective), though few in number, are consistent in showing a significant reduction in risk. The issue is far from settled; four ongoing studies should provide definitive answers within the next five to seven years.

If estrogens really do reduce the risk of Alzheimer’s, that would change the risk:benefit equation. There would then be an even great focus on developing more estrogen-like drugs that could provide the benefits without the risks.