I'm 68 and i don't want to come off estradiol...what should i do? dr. christensen, i'm 68, had a partial hysterectomy (ovaries left) @45, i went on estradiol 2mg at @53. my daughter, who is a nurse, said i had to come off @66 because i had been on too lon

I'm : I'm very happy you made a choice based on the quality of your own life - that is ultimately the way to go. Hormone therapy is much safer than the media makes it out to be, especially when the hormones used are bioidentical. Because you do not have your uterus, you are not at risk for uterine cancer from the Estradiol you are taking. I do not believe you are increasing your risk of breast cancer either. The debate around hormone therapy and breast cancer mostly skips over several very large studies (both in the U.S. And in europe) that show that the increase in breast cancer risk with hrt is due to synthetic progestins, which are not the same as bioidentical progesterone. In your case, as we said, you don't need any progestin to balance the estrogen. (notice i did not say you don't need any Progesterone - this can help with sleep quality, anxiety and mood, and does not increase your risk for breast cancer as long as it is bioidentical - Prometrium (micronized progesterone) or compounded progesterone.) on the other hand, you are at a relatively increased cardiovascular risk because you are taking oral estrogen. If there is any way you can change it to a form of Estradiol through your skin (gel, cream, or patch), then you will significantly lower your risk of cardiovascular side effects such as stroke, heart attack, and peripheral blood clots. Some women really need the oral estrogen, such as if the transdermal forms do not work well for them. If this is the case for you, then we are back to quality of life as the way to decide. The absolute risk of any of these cardiovascular events is small; it is the "relative" risk that is increased. So, especially in light of all the potential benefits of estrogen, i recommend going for feeling the best you can for as long as possible.

I'm : I'm sorry things didn't go well when you stopped taking the estradiol. As you've discovered, for many women estrogen is invaluable for controlling hot flashes and other menopausal symptoms. In addition, Estradiol helps preserve bone mass -- a crucial issue for women who are at risk for osteoporosis -- but prolonged use of Estrogens has been linked to a higher risk for breast, ovarian, and uterine cancers. Since you don't have a uterus, the latter problem doesn't pertain to you, and periodic mammograms will hopefully detect any breast cancers before they gain a foothold. However, there are no widely used, effective means of screening for ovarian cancer. This is where you and your doctor have to weigh the benefits of Estradiol therapy against the risks. For what it's worth, lowering your Estradiol dosage as much as possible will ameliorate your cancer risk. Dr. Duane townsend, author of "a maverick of medicine speaks to women, " recommends 0.5 mg of Estradiol every other day along with a daily dose of soy-based genistein (35-70 mg) for women who have menopausal symptoms. (for women who still have a uterus, he also recommends progesterone.) there's some pretty compelling evidence that soy isoflavones offer some protection against estrogen-driven cancers, but this issue is still hotly debated in medical circles. When used appropriately and cautiously, Estradiol has obvious benefits. Discuss your concerns with your gyn. He/she can review the risks associated with long-term Estradiol use and outline a cancer-screening program that most suits you. I hope that helps, and good luck!