The reluctance of physicians to use
estrogens in women with
hormone responsive disorders is a tragic result of the 2002 WHI study. Although their hostility to
estrogen therapy antedated these studies, the flawed data is now used as justification for the denial of
estrogens for treatment of
low bone density and various types of
hormone responsive depression in women.
Estrogens should be first choice
therapy for
osteoporosis in women under the age of 60 years, but in practice
bisphosphonates, with its increasing number of long-term side-effects, has become first-line
therapy for physicians. These side-effects include
osteonecrosis of the jaw, mid-shaft
femoral fractures and the need for
proton pump inhibitors, which further reduce bone density and add to the fracture risk. Psychiatrists fail to use transdermal
estradiol for
postnatal depression, premenstrual depression and perimenopausal depression in spite of randomized trials demonstrating their efficacy.
Selective serotonin reuptake inhibitor therapy for depression independently decreases bone density and is also responsible for loss of libido, loss of mental acuity and dependence. Thus postmenopausal women with vasomotor symptoms, depression, loss of libido, vaginal dryness or
low bone density are frequently denied effective
estrogen therapy and given a combination of low-cost generic
prozac and
fosamax, which is in danger of becoming a post-WHI nightmare
drug PROFOX (PROzacFOsamaX). This can only be avoided if advisory bodies review the reassuring evidence concerning
estrogen therapy in women under the age of 60 years and advise accordingly.