It is becoming increasingly clear, that post menopausal estrogens, are more trouble than they
are worth. Their known side effects are disturbing ( breast cancer, vein and lung clots, stroke, and
uterine cancer ). Moreover, the original justification of heart disease protection, is coming under
attack by new and well done studies. About the only proven, and yet undisputed benefit, is bone
preservation. With the availability of superior bone preserving medications, this last benefit of
estrogens, may have outlived its usefulness. Cardiac protection can be obtained by well known
methods of prevention, and effective drugs.

      There is a subset of women with severe hot flashes and depressive/anxiety states attributable to menopause who are perhaps the ideal candidates for post menopausal estrogens, provided they
are not at high risk for clotting abnormalities, stroke and heart disease.

      Synthetic estrogen ( Evista ) has breast cancer reduction properties, along with all the other
benefits of estrogen. Evista does not cause increased uterine cancer.  Tamoxifen, is a breast cancer fighting drug, that shares estrogen's bone preserving benefit. Both Evista and Tamoxifen, can cause clotting abnormalities( leg vein , lung clots, and strokes ). They also may worsen hot flashes. Tamoxifen was recently shown to increase the incidence of Uterine cancer. If Evista is shown in an ongoing study
to clearly reduce breast cancer, it will be the clear favorite over Tamoxifen for breast cancer prevention.

       Finally, Phyto-Estrogens are plant derived estrogens with the added benefit of being anti-estrogenic
in the breast and uterine tissue. This implies possible benefit in reducing breast and uterine cancer risk. Definitive studies are lacking. Soy products and flax seed contain phyto-Estrogens.