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Patches and pills have different effects, said Dr. S. Mitchell Harman, an endocrinologist and director of the Kronos Longevity Research Institute, a Phoenix-based group with no industry ties that paid for the study. Oral estrogen goes straight to the liver, resulting in higher concentrations than when it’s absorbed through the skin. That raises blood-clotting factors that might be especially harmful to smokers. But higher estrogen levels also cause the liver to make more HDL, or good cholesterol. So estrogen can have good and bad effects depending on the form, he said.

Skin patches account for just 2 percent of hormone use, some studies estimate. Besides Climara, at least one other is on the market _ Vivelle-Dot, sold by Novartis and Noven Pharmaceuticals Inc. A generic version is expected in about a year.

Dr. Sanjay Asthana, a geriatrician at the University of Wisconsin-Madison, led a separate analysis that found estrogen pills and patches improved depression and anxiety but had no effect on cognition or memory. The National Institute on Aging paid for that study.

Women need to realize the new study is much less definitive than the big federal one that found more lung and breast cancer deaths among women on estrogen-progestin pills, said one researcher involved in the earlier work, Dr. Rowan Chlebowski of the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center. It would be unwise to try to prevent certain health problems by using a treatment “that increased the two leading causes of cancer deaths in women,” he said.

Manson agreed that hormones should be used only for severe symptoms. Two study participants found they helped.

“My mood leveled out. I found that I was just generally calmer” on the estrogen patch, said Kathy Smerko, 60, a nurse practitioner from Phoenix.

Dianne Fraser, 56, an accountant from suburban Boston, said the patch eliminated the drenching sweats that woke her in the night. She was able to quit treatment after five years and seldom has problems now.

“It was enough to get me through that crazy period” right after menopause began, she said.

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Online:

Estrogen patch/pill study: http://www.keepstudy.org/

Women’s Health study: http://www.nhlbi.nih.gov/whi/estro_pro.htm

and http://www.nhlbi.nih.gov/whi/background.htm

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP.