Ladies, if you’re confused about whether or not you should continue to take hormones to protect your heart after menopause, I don’t blame you.
Over the last two decades no one seems to be able to make up their minds, and women have gotten many mixed messages.
In the 80s and 90s we were telling women that estrogen therapy would protect their heart when they hit menopause.
That was until the devastating results of the Heart and Estrogen/Progestin Replacement Study (HERS) and the Women’s Health Initiative studies were published.
The data revealed that the therapy was doing more harm to women’s hearts than good. And despite the fact that the hormone therapy showed other benefits, most women were advised to stop using the therapy because of the potential heart dangers.
Weighing the benefits and risks of estrogen therapy
But now, you may have heard, some experts are starting to once again reevaluate the use of estrogen therapy as emerging research reveals we have more to learn about the benefits and risks for women after menopause.
Two studies have revealed that we may in fact need to be looking at more specific time frames when it comes to the benefits and risks of estrogen replacement.1,2
It turns out that during the first six to ten years of menopause taking estrogen can lower your risk for heart attack or stroke, according to two studies published in the New England Journal of Medicine. But when you reach the ten to twelve year window, estrogen can make your heart risk climb.
Here are the three things you need to know…
One: The type of progesterone used is critical
Typically, progesterone is taken along with estrogen. But what many folks don’t realize—and tragically this includes far too many doctors—is that the type of progesterone used is critical to how well a woman does on the therapy, no matter what her age is.
Medroxy progesterone (MPA) is a synthetic form of progesterone that you should steer clear of. MPA increases your risk for heart disease and breast cancer. Despite the dangers MPA remains on the market and some doctors continue to put women in danger by prescribing it. Make sure you know what progesterone your doctor is prescribing for you.
Beyond Provera there are progestins, a class of pseudo progesterone drugs. Since drug companies are unable to patent natural bio-identical progesterone they tinker with it at the structural level to create “unique” compounds that they can patent.
The trouble is, when you compare these near clones to natural progesterone the risk for dangerous side effects, such as heart problems, goes up.
I recommend micronized bio-identical progesterone. Adverse effects haven’t been found with this form of the hormone. If you’re already taking a progesterone I suggest you talk with your doctor about switching to this form. Just be sure to ask for oral progesterone rather than topical for the most reliable absorption.
Two: Bio-identical TOPICAL estrogen is best
When it comes to estrogen I recommend natural, bio-identicals as well. Estradiol is the most popular bio-identical for treating menopause symptoms. However, once again, the form of the hormone therapy can have a huge impact.
According to a study published in the journal Circulation, oral estradiol increased inflammation levels (hs-CRP) by 192 percent and blood clot risk by 400 percent, when compared to topical estrogen.3
If a women is using estrogen I almost always prefer she use a patch or topical cream. If you’re already on an oral estrogen I recommend you talk with your doctor about the possibility of switching to a topical version. But keep in mind that many doctors still aren’t aware that the FDA has approved several topical estrogens, so you may need to bring him or her up to speed.
Three: Timing is VERY important with estrogen therapy
Back to those two studies I mentioned earlier. We now know that when it comes to the benefits (and risks) of estrogen therapy, it’s all about the timing.
Research has shown that for the first six years of menopause estrogen therapy delivers more benefits than it does risks. This is even truer if you use the bio-identical micronized progesterone and topical estrogen that I recommend.
However, after 10 years it’s time to have a serious talk with your doctor about the benefits versus the risks of continuing on estrogen therapy.
We now know that once you enter this window your risk for stroke or heart attack rises. So this increased risk has to be weighed against whatever other benefits you’re getting from continuing the therapy.
1. N Eng J Med 2016; 374: 803-6.
2. N Eng J Med 2016;374:1221-1231.
3. Circulation 2007;20:340-5.
Dr. Masley has received the award of Fellow from three prestigious organizations: the American Heart Association, the American College of Nutrition, and the American Academy of Family Physicians. He is also a Clinical Assistant Professor at the University of South Florida, and he teaches programs at Eckerd College and the University of Tampa. In 2010, he received the physician Health Care Hero award by the Tampa Bay Business Journal, plus he has received several awards for his lifestyle related research. Dr. Masley sees patients from across North America at the Masley Optimal Health Center in St Petersburg, FL.
Dr. Masley has published several health books, including Smart Fat, The 30-Day Heart Tune-Up, and Ten Years Younger, and numerous scientific articles. His work has been featured on the Discovery Channel, the Today Show, Public Broadcasting Service (PBS), plus over 250 media interviews. He also completed a chef internship at the Four Seasons Restaurant in Seattle, WA, and he has performed cooking demonstrations at Canyon Ranch, the Pritikin Longevity Center, and for multiple television appearances.
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