Choosing whether or not to use menopausal hormone therapy is one of the most complicated health decisions women must make. Few medical topics are in such a state of flux and controversy as hormone therapy for menopause. The most contradictory and confusing concerns about HT relate to heart disease and breast cancer.
Regarding heart disease, the timing relative to the onset of menopause appears to make a key difference. Most studies have found that women who began HT at the onset of menopause had a significantly lower risk of cardiovascular disease than women who did not use HT. In contrast, women who began HT when they were 20 or more years past menopause had an increased risk of heart disease (Fritz & Speroff, 2010). This variation is likely due to the effects of aging on the cardiovascular system. Prior to menopause, estrogen has a protective effect, and if a woman begins taking estrogen at menopause, it helps maintain the health of her cardiovascular tissue. When a woman waits many years after menopause before taking estrogen, the estrogen can cause the plaque that has formed in the intervening years on the walls of the veins and arteries of the heart to separate from the tissue, form clots, and cause heart attacks (National Cancer Institute, 2011b; Taylor & Manson, 2011).
Whether a woman takes estrogen or a combination of estrogen and progesterone makes a difference in breast cancer risk. Women who do not have a uterus can take estrogen only, whereas women with a uterus use both estrogen and progestin. Research currently indicates the following: Women who took only estrogen for hormone therapy had a 23% lower risk for breast cancer compared with those who had taken a placebo (LaCroix et al., 2011). Compared to the placebo group, women ages 50 to 79 who used estrogen and progestin HT had a greater incidence of breast cancer and a higher number of deaths from breast cancer—2.6 deaths per 100,000 compared to the placebo group’s rate of 1.3 deaths per 100,000 (Chlebowski et al., 2010). To keep the increase in perspective, it is important to note that the 1.3 per 100,000 death rate is less than is associated with the risk factors of a positive family history, being overweight after menopause, or alcohol intake (Fritz & Speroff, 2010).
It is important for vaginitis to be treated and cured. Chronic irritation from longterm infections can play a part in predisposing a woman to cervical cell changes that can lead to cancer. The following suggestions may help prevent vaginitis from occurring in the first place (Solomini, 1991):
1. Eat a well-balanced diet low in sugar and refined carbohydrates.
2. Maintain general good health with adequate sleep, exercise, and emotional release.
3. Use good hygiene, including (a) bathing regularly with mild soap; (b) wiping from front to back, vulva to anus, after urinating and having bowel movements;
(c) wearing clean cotton underpants (nylon holds in heat and moisture that encourage bacterial growth); (d) avoiding the use of feminine-hygiene sprays and douching, colored toilet paper, bubble bath, and other people’s washcloths or towels to wash or wipe your genitals; and (e) ensuring that your sexual partner’s hands and genitals are clean before beginning sexual activity.
4. Be sure that you have adequate lubrication before coitus, either natural lubrication or a water-soluble lubricant. Do not use petroleum-based lubricants (such as Vaseline), because they are not water soluble and are likely to remain in the vagina and harbor bacteria. Petroleum-based lubricants can also weaken, and will eventually degrade, latex condoms or diaphragms.
5. Use condoms if you, or your partner, are nonmonogamous. •