Did you ever notice that only the so-called “bad” news about menopause and hormones seems to get our attention? Yet almost daily I am reading about new research and information about the benefits of hormones – so I thought I would share with you some of the good news for a change. (Although I am not recommending estrogen to prevent heart disease in women, estrogen is used to treat the distressing symptoms of menopause and is often the only thing that really works!!)
Earlier this year we learned that the timing of hormones makes a big difference to the heart. Women who start hormones in the form of estrogen soon after menopause may actually prevent heart disease because the estrogen improves blood cholesterol and relaxes the heart arteries. Older women who start hormones 10 years or more after menopause may actually have a greater risk of heart attacks because their heart arteries already have plaque build-up, are stiffer, and adding estrogen does little if any good for the heart. In fact, taking estrogen in pill form can actually lead to increased clotting of the blood and may partly explain the higher heart attack risk in older women. (The skin patch or transdermal delivery of estrogen does not seem to cause this blood clotting effect because it bypasses the liver – and to my mind is the safest and best way to take estrogen.)
In July, the New England Journal of Medicine reported again on the findings of the estrogen-only part of the large government study referred to as the Women’s Health Initiative. The women in this study who took estrogen only (that means they did not need to also take progestin because they had a hysterectomy) did NOT have a higher risk of heart disease. In fact the women who started estrogen around the time of menopause rather than many years later seemed to actually benefit from estrogen.
To understand why their hearts may have had a benefit, the women in the research study agreed to undergo an ultrafast CT scan of their hearts. This is a special scan that takes many close up pictures of the heart and counts up the amount of calcium present in the heart arteries. The more calcium you have (also called calcium score), the more dangerous plaque build-up in your heart arteries. No calcium means virtually no calcium or plaque build up and is great news. The women who took estrogen had up to a 60% lower chance of having calcium build-up in their heart arteries than the women who took the sugar pill. This is great news and helps explain exactly why younger women on estrogen had lower heart risk.
Any woman (or man for that matter) who is at high risk for heart disease should talk to their doctor about the pros and cons of a heart scan. Although insurance may not always pay for it, the scan does often give you and your doctor helpful information that assists you in making the best decisions for your heart health.
Although I wrote an entire chapter on hormones and women’s health in my last book, THE BODY SHAPE SOLUTION TO WEIGHT LOSS AND WELLNESS, here once again is my general advice to women.
If you are in the throws of menopause and you want to give hormones a try – don’t hesitate to talk to your doctor about the pros and cons of estrogen given your unique medical history. There is no “one size fits all” solution but there are some general themes. If your doctor agrees hormones are okay for you to try to treat your menopausal symptoms, consider taking estrogen in the transdermal or patch form beginning at a low dose. As I mentioned earlier, research seems to suggest that the patch form of estrogen (or any estrogen delivered through the skin including the new estrogen spray recently approved by the FDA) may be preferable because it does not cause an increase in blood clotting, does not cause an increase in blood inflammation or an increase in the C-reactive protein test, and it does help to improve blood cholesterol. There are a few different skin patches available but they all deliver the same estrogen (e.g. Vivelle or Climara).
For women who still have their uterus (1/3 of women have had a hysterectomy) – then some form of progesterone (either synthetic progestin’s or natural progesterone) is necessary to balance out the estrogen in your uterus and eliminate any risk of uterine cancer. I like Prometrium because it is a natural progesterone pill that is taken up to 12 days every month or so. It has been shown to have few if any side effects or other effects on your body.
Stay tuned for more updates on hormones in the near future. Okay, I confess, I am in menopause myself and get hundreds of questions about the many different varieties of hormones. I can’t help but pay close attention.
As always, I welcome your comments and questions.