Should you use hormone replacement therapy (HRT)? That is the question for many women approaching menopause. The decision has become more complicated in light of new research that shows that even though estrogen lowers cholesterol, it doesn't necessarily protect coronary arteries.

Preliminary results of a major long-term study suggest that HRT in post-menopausal women may actually increase chances for stroke or heart attack. This is from a study called the Women's Health Initiative conducted by the National Heart, Lung and Blood Institute in Bethesda, MD.

Circulating estrogen has long been touted as protecting the heart from heart disease. But, estrogen dramatically increases the risk of endometrial (the lining of the uterus) cancer. It was discovered that adding progesterone can counteract the danger of uterine cancer. Estrogen also increases the risk of breast cancer. Now it appears that progesterone can increase the risk of breast cancer also (Journal of the American Medical Association, Jan. 26, 2000). Doctors point out that heart disease kills more women per year than breast cancer.

But if, as scientists now suspect, estrogen does not prevent heart disease, then the benefit-risk ratio changes significantly. The Estrogen Replacement and Atherosclerosis (ERA) study just out demonstrates that neither Premarin (estrogen) or Prempo (estrogen plus progesterone) is better than a placebo at preventing plaque from building up in coronary arteries. This new information creates confusion for women.

Research is being carried out all the time on the effects of hormone replacement therapy, so that new findings are reported every few months. A woman and her practitioner need to assess the pros and cons of HRT. Now more than ever, each woman's individual medical history, risks and fears must be considered.