Dear Sirs,

It seems that the authors of your article on estrogen are seriously
underestimating the intelligence of American women. As a Certified
Menopause Clinician, a member of the North American Menopause Society, a gynecologist who has dealt with female hormonal issues for nearly 20 years, and a woman who is approaching menopause myself, I am sure that
the women of America are much too smart to fall for your short- sighted view of hormone replacement therapy.

First, they are smart enough to realize that it was only the Prempro arm of the WHI study that was discontinued and that the Premarin arm continues without problems. So if any hormone is to be questioned it would be the progestin part of Prempro, not the estrogen. There are many alernatives to medroxyprogesterone acetate (the "pro" part of Prempro) already in use. And
they'll wonder why Newsweek is focusing on estrogen and not on
medroxypoorgesterone acetate.

Secondly, they will be smart enough to find out that the death rate in the Prempro arm of the study (the part that was cancelled) was actually
lower than that in the placebo arm. And they will wonder why the drug
that had less death than placebo was being questioned by the committee running this study.

Thirdly, they will realize that the average woman starting this study was over sixty three years old, had already spent an average of 12 years without estrogen, and was quite a bit on the chunky side, (BMI over 28). They will also find out about the EPAT study published Dec 2001 in the
Annals of Internal Medicine which showed that even two years of estrogen deprivation at the onset of menopause causes significant atherosclerotic changes in vessel walls which were entirely prevented by replacing estrogen. And it's not rocket science to conclude that 12 years of
estrogen deprivation probably allows quite a bit of hardening of
arteries to occur. So they will figure out that the Prempro arm of
the WHI study really wasn't measuring the effect of estrogen on women with healthy blood vessels, but measured the effect of estrogen plus synthetic progesterone on older, heavy women who most likely had some
significant vessel damage already.

Lastly, cost conscious American menopausal women will realize that the drugs that you have recommended as an alternative to taking estrogen, including Prozac for hot flushes, Fosamax for bone, and Lipitor for lowering cholesterol, will cost them approximately $302 for a month
supply when a month of Prempro will cost them $47.00 and will work as well if not better. Perhaps they will also wonder if the companies
that make these alternative drugs, which will profit tremendously if
Prempro disappears, have any connections with those making decisions about the WHI study. I certainly do.

So I hope that your authors will reconsider their attempt to convince women that they should not replace the hormones that keep them healthy and comfortable (if started at the onset of menopause and not 12 years later!). I personally know thousands of women who will agree that estrogen replacement has been a godsend both for them and for those who
love them. Perhaps you should talk to some of them.

Donna Hurlock, MD
Alexandria, VA.


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