Estrogen therapy: Overall risks may outweigh benefits

September 11, 2013

Q. What is the value of taking hormones for menopause?

To help control menopause symptoms, there is Hormone Therapy or Hormone Replacement Therapy.

The most comprehensive evidence about taking hormones after menopause comes from the Women’s Health Initiative Hormone Program sponsored by the National Heart, Lung, and Blood Institute and the National Cancer Institute.

The WHI Hormone Program involved two studies - the use of estrogen plus progestin (a synthetic progesterone), and the use of estrogen alone. Women who have undergone a hysterectomy are generally given estrogen alone. Women who have not undergone this surgery are given estrogen plus progestin, which have a lower risk of causing cancer of the endometrium, the lining of the uterus.

The estrogen/progestin study was stopped in 2002, when investigators reported that the overall risks outweighed the benefits. The estrogen-alone study was stopped in 2004, when the researchers concluded that estrogen alone increased the risk of stroke and blood clots.

I have read opinions from doctors who say that HRT may be okay for some women. The best course is to get a personal assessment from your own physician.

Q. Any advice about how to stay healthy during a trip abroad?

Here are a few tips:

• First, see your doctor and your dentist to make sure you are starting the voyage in good condition. You may need vaccinations.

• Guard against infection by washing your hands often, especially after you’ve been on a plane, train or bus.

• If you are in a country where traveler’s diarrhea is common, avoid street vendors, uncooked food, unpasteurized dairy products, tap water and ice.

• To battle jet lag, drink a lot of water on your flight.

• Get up and walk on a plane or train to protect yourself against blood clots forming in your legs.

• If you suffer from motion sickness, make sure your eyes are seeing the same motion that your body senses. For example, on a rocking boat, go up on deck and watch the horizon. Don’t sit in a windowless room below deck where your body feels movement, but your eyes don’t see it. That difference is what makes you seasick.

Q. What exactly happens during LASIK eye surgery?

LASIK, which stands for Laser-Assisted In Situ Keratomileusis, improves vision by reshaping the cornea, the clear covering of the front of the eye. Using a laser, an eye surgeon can free patients of eyeglasses and contact lenses.

During the eye exam prior to LASIK, the surgeon charts your eye to determine which areas of your cornea need to be altered. The surgery is then done with a laser programmed to remove the right amount of tissue in each location on the cornea.

During the surgery, you lie on your back in a reclining chair in an exam room. The surgery usually takes less than a half hour. Often, LASIK is done on both eyes in the same sitting. In most cases, your vision won’t be better at first. Vision improves over several months.