Saturday, October 28, 2006

How could a postmenopausal woman decide between hormone therapies?

Choosing between tamoxifen, the standard therapy, and one of the newer aromatase inhibitors still remains somewhat tricky. On the one hand, there is no question that the likelihood of events is reduced when you take one of these new drugs over the short run. The big question is what do they do to bone density because aromatase inhibitors significantly lower estrogen, and that decreases bone density.

On the other hand, tamoxifen has some fairly well-described short-term side effects like an increased risk of uterine cancer and aside from that, an increased risk of vaginal complaints like bleeding or discharge. And these things seem to be less of an issue with the aromatase inhibitors. There is also an increased risk of blood clots with tamoxifen, and maybe stroke and even heart attacks. So we have to consider all these issues carefully. Obviously a woman, for example, who has had her uterus removed, has taken away one of the concerns with tamoxifen.
We simply don't know what the very best strategy is, so I think we have to say that doctors and their patients will have to individualize treatment.

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