fivefold. There followed a dramatic decrease in the use of ERT. More recently, evidence has shown that the use of progestin, a hormonal supplement similar to the natural hormone progeste-rone, for l0 to l4 days at the end of each 25 day regimen of estrogen is protective against uterine cancer. Estrogen is now available in a number of different preparations as well as both orally and in patches, which have the definite advantage of bypassing the liver.If you decide to go ahead and use ERT, consider the various forms carefully before deciding. Menopause Naturally provides good information on this subject. Some of the disadvantages of ERT are continued monthly periods, as least for a while, the need for regular gynecologic visits, the expense of the hormones, and the possibility of uterine cancer, liver or gall bladder disease, high blood pressure, clots, strokes, and depression. Though progesterone does lower the incidence of uterine cancer, it also can predipose to weight gain and may be implicated in high blood pressure, stroke, heart disease, and breast cancer.

Be sure to get all the information before deciding one way or the other about hormones. Similar to deciding whether to receive immunizations, it's a very personal decision with possible consequences way after the actual decision is made. Menopause can be a natural process rather than a disease. Many women got along quite well through menopause before the intro- duction of estrogen replacement and still do in many cultures. The philosophy that "every woman needs to continue having periods in order to stay healthy after menopause and avoid osteoporosis" is, I feel, absurd.

What about osteoporosis? Osteoporosis is a demineralization of the bones which occurs after menopause to a serious degree in about 25% of white, Asian, and brown-skinned women. Black women have thicker bones, which puts them much less at risk for osteoporosis. This softening and weakening of the bones is what causes the fractures we often hear about in older women. Many women are very cautious about falling and breaking a hip; however if a woman has severe osteoporosis, her bones can break anytime, even from just walking across the room. It is possible to assess your risk level of osteoporosis through such tests as DPA (dual-photon absorptiometry) which measures the density of bone in the vertebrae of your lower back, or a CT scan, which offers the same results but has a consequence of greater exposure to radiation, as well as through an X-ray of the bones of the hand. These tests may be current state of the art, but still do not offer a really accurate predictor of risk of osteoporosis. A cruder method is to measure your height a year or two after menopause and compare it to your former height.

There are some definite steps you can take to decrease your risk of osteoporosis. Women who are slim with small muscle mass, particularly if they are short, are at increased risk. SO, in this case, it's actually good to keep a little extra fat on your bones. This is because estrogen is stored in fat cells. This is not to suggest, however, to gain a lot of weight, which would increase your incidence of heart disease. Other factors which increase your risk of osteoporosis are a history of repeated, easily broken bones, a family history of osteoporosis, menopause prior to age 40, daily use of cortisone , thyroid, Dilantin, or aluminum-containing antacids, renal dialysis, or chronic ciarrhea or surgical removal of part of the stomach or small intestine. There is clear evidence that women with a low protein intake decrease their risk. The best thing you can do for yourself, especially, but not only, if you prefer not to take ERT, is to eliminate red meat from your diet. Taking the next step of avoiding chicken and fish, also animal proteins, further decreases your risk. Other ways to lower your risk are to avoid or minimize alcohol and caffeine, not smoke, minimize salt, exercise regularly, and be sure to supplement calcium and vitamin D.