Category Archives: Women’s Heart Disease

5:2 Mediterranean Diet

Your Heart – Prevent & Reverse Heart Disease in Women, Men & Children

The 5:2 Eating Plan

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♥ If you look to the future in defeat and say to yourself there is no way I can lose 20, 30, 50 or 100 pounds. Ask yourself this: Can I cut back my calories one day each week? How about cutting back two days a week?

On the 5/2 Plan you eat about 500 calories one day, then eat a regular healthy Mediterranean cuisine or plant-based cuisine the next one or two days, then you eat only 500 calories the next day, resume regular eating the rest of the week and repeat this ongoing. Your overall calorie intake drops gradually and you lose weight.

In 2012, Dr. Michael J. Mosley shared his concept of eating less than your usual intake for two non-consecutive days a week. With this plan, you reduce your calorie intake significantly but it is not as mentally challenging as setting out to sharply curtail eating for the indefinite future. His concept is to have men eat about 600 calories and women about 500 calories on two non-consecutive low calorie days.

Dr. Mosley’s examples of food choices on the low-intake days are: two eggs and lean meat with water, tea or black coffee; a second meal of grilled fish or meat, with vegetables. Vegetable Tray-1You can make breakfast healthier by throwing out the yolks and eating a side of non-processed protein choices, such as a heap of steamed veggies. (Veggies high in protein include broccoli, mushrooms, soybean sprouts, tomatoes and onions, to name a few.)

Although fasting has been advocated for decades in many groups, harsh diets often fail miserably because metabolic changes related to starvation trigger the body to store up calories and as soon as you begin eating normally, you regain weight.

To be effective and long-lasting, the manner of eating must be sustainable. It must be a way of life — something you can do for the rest of your life. If you have a lot of weight to lose, this would be a life-changing method of gaining control of your eating and reducing Weight control scale and tapeweight. To review: one pound = 3500 calories. If your normal intake is 2500 calories/day and you eat 500 calories two days/week, your weight loss each week would be more than one pound. This is approximately 4-5 pounds per month and 48-60 pounds in a year. In addition, if you choose lower calorie foods, less fat and sugar, you may lose more. Most people find this plan easy to follow for long periods.

Animal studies examining the effects of fasting have shown heart benefit with reducedBlood pressure.2 blood pressure and lower cholesterol levels. Intermittent fasting also lowered diabetes development in lab animals.

Because Dr. Mosley’s unique concept of marked calorie reduction for two out of five days lacked scientific evidence to support the process in reduction of heart disease and diabetes in humans, I was hesitant to include it in this evidence-based book. However, as I was writing this portion of the book a very exciting scientific review in the British Journal of Diabetes and Vascular Disease was published!

An Aston University team in the UK, led by Dr. James E.P. Brown evaluated various approaches to intermittent fasting, looking for any evidence of advantage for its use in treating Type 2 diabetes. In their review, they found intermittent fasting was just as effective, possibly even more effective, than daily calorie restriction and calorie counting. Other favorable findings: markedly low calorie days (not true fasting) can reduce inflammation, reduce both glucose and lipids, and reduce blood pressure.

True fasting lowers metabolic rate and making it harder to burn fat and lose weight. Reduced metabolic rate is protective in a prolonged starvation state and impacts the ability of people today to lose weight. Researchers believe the gene pool of those who were able to survive periods of starvation has been retained in today’s population. Examples are the American Indians and many Polynesian cultures that are experiencing obesity and Type 2 diabetes epidemics.

Their bodies evolved to become efficient in saving calories for harsh times. The problem today is, food is plentiful and the ability to efficiently save the energy in fat stores has become detrimental instead of life-saving.

In the 5/2 plan, eating less on two non-consecutive days is unlikely to lower your metabolic rate and trigger the starvation response. For example, choose Monday women walkingand Thursday as your low calorie days and add daily exercise to your weight loss plan, Exercise is an essential component to health improvement and longer life.

Pregnant women and people with Type 1 diabetes should not fast.

If you are interested in the 5/2 diet, check with your physician and obtain guidance regarding your medications during the low calorie days, especially if you are a Type 2 diabetic taking medications to lower blood glucose. Monitor blood glucose carefully and avoid readings that are too low.

There are many studies showing great benefit by delaying Type 2 diabetes, reversing glucose elevations and reducing insulin resistance with weight loss. Dr. Brown and his team are preparing clinical trials to evaluate the 5/2 dietary format as interventions in various clinical settings.

An excerpt from: Your Heart – Prevent & Reverse Heart Disease in Women, Men & Children

Betty and Bev

Your Heart Book Cover- Final 1

Your Heart

 

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♥ Protect Your Heart ♥

February is American Heart Month

Cardiovascular disease is the number one killer of women and men. February is a great time to review your health history and explore actions to reduce risks for dying of heart disease and stroke. Heart risk factors and actions:

♥ Tobacco use and cessation

♥ High blood pressure identification and treatment

♥ Cholesterol abnormalities paired with dietary modification and statin use when needed

♥ Low activity levels counteracted with exercise prescriptions

♥ Alcohol consumption history and limitation of use

♥ Heredity factors and recommended interventions

To help you take control and make 2018 a healthier year, we are offering our book free on February 13, 14 & 15. In just two-hundred pages, Your Heart will give you the science behind the disease, some actions to improve your health and common interventions that could save your life or the life of a loved one. This includes information on the Mediterranean 5/2 diet, a safe and easy way to reduce weight and maintain a healthy weight for life.

YOUR HEART –

Prevent & Reverse Heart Disease in Women Men & Children

♥ FREE FEBRUARY 13, 14 & 15♥ 

HAPPY VALENTINE’S DAY

BETTY and BEV

PROTECT YOUR HEART

Fewer people are dying from heart attacks. Education, healthy changes in lifestyle and diet have made Two Red Heartsdramatic improvements. Additional life-saving interventions include rapid treatments to open closing vessels interrupting heart attacks. Dilation and placement of stents open a closing vessel and returns blood flow to the heart muscle before damage occurs. We have made strides in reducing heart deaths in recent years, but cardiovascular disease remains the number one killer of both men and women.

The key to heart health is early action to alter contributing factors. If you recognize worrisome chests symptoms seek healthcare immediately. Call 9-1-1.

Take control of your health through education and action. Basic actions:

  • Exercise – Thirty minutes of exercise a day contributes to improved health
  • Eat Right – Cut calories by reducing fat, sugar and portion sizes
  • Drink – Water, coffee or tea. Stop drinking diet and sugared sodas.
  • Read – Learn how to improve your health and take control
  • Visit a health practitioner: Know your numbers for blood pressure, cholesterol and glucose

National Wear Red Day is Friday February 3, 2017

The American Heart Association started the Go Red for Women national movement to improve education helping women learn their risks and take action. I wrote Your Heart- Prevent & Reverse Heart Disease in Women, Men and Children to provide a concise reference with broad information on heart health, diet, exercise with details to take action. Heart disease the #1 killer of women causes 1:3 deaths each year.

Your Heart – Prevent & Reverse Heart Disease in Women, Men & Children

Your Heart Book Cover- Final FINAL

Your Heart Book on Amazon

Price reduction: Kindle $2.99, Paperback $9.99

https://www.goredforwomen.org/

https://yourheartbook.com

ESTROGEN IS BACK IN THE NEWS

Estrogen Supplements May Reduce Dementia Risks

musicinbrainTwo recent studies show a possible benefit of estrogen supplements in menopausal women to reduce dementia risk. These studies are very important because women are living longer and any improvement in mental function or delay in the onset of dementia could provide great benefit for women.

Loss of ovarian hormone production following menopause or surgical ovarian removal, results in important changes throughout the body. Bone density decreases, osteoporosis develops and more fractures occur. Hot flashes, mucus membrane dryness, reduced libido, hair loss, skin wrinkling, all become issues. The list goes on. Some problems related to estrogen loss seem minor, but decreasing risks for heart disease, osteoporosis and dementia are major considerations for long term health.

In the past, physicians provided prescriptions for hormone replacement therapy (HRT) for women following menopause. In the summer of 2002, physicians stopped prescribing hormone replacement therapy after the Women’s Health Initiative (WHI) concluded the risks of estrogen treatment far outweighed its benefits. The large WHI study also reported the combination of estrogen plus progestin not only increased the risk of both breast cancer and heart disease, but women had an increased risk for dementia.

The following studies suggest estrogen alone (without progestin) may be beneficial for the brain and memory and not detrimental as the WHI study reported:

+ Neurobiology of Aging published a Norwegian study where researchers studied MRI scans of women taking estrogen. They found an important area for memory, the hippocampus, showed preserved brain volume in women who started taking estrogen supplements before or at the beginning of menopause and continued for a number of years. Since the hippocampus is the area affected in the progression of Alzheimer’s disease, the findings in the Norwegian study are hopeful.

+ The National Proceedings of Science reported that a team of scientists at Guelphsynapse photo University in Ontario studied the effect of estrogen on synapses in mouse brains, the location where brain cells communicate. Within minutes of an estrogen injection, a large increase in synapse activity occurred in the hippocampus. Boosting estrogen levels may help strengthen brain connections and result in improved learning and memory. Human studies are needed to validate their findings and any long term benefit.

WHI conclusions are being revisited by practicing physicians and research groups. Estrogen replacement in women may once again be prescribed as an anti-dementia aid. However, if a woman has had clots, strokes or cancer, estrogen is not appropriate.

For additional information on benefits of estrogen from new studies see our blog at:Your Heart Book Cover- Final FINAL
www.yourheartbook.com

http://tinyurl.com/mvpm2y9

The Benefits of Daily Exercise after Menopause

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Women experience menopause with lost ovarian function due to aging or surgical removal. Loss of estrogen in the postmenopausal state affects the body in both obvious and subtle ways. Obvious effects are hot flushes, thinning hair and skin wrinkling, but there are many more silent harmful effects.

Early menopause contributes to osteoporosis. Gradual weakening of bones occurs without the estrogen stimulus to calcium metabolism and bone strength. Further bone loss may evolve to fractures and disability.

We also know the effectiveness of high-density-lipoprotein (HDL), the “good” blood fat, is reduced without estrogen effect. This transporter molecule is responsible for removing cholesterol buildup in arteries. HDL particles without the effect of estrogen are less efficient and the risk for heart attacks increases in women following menopause. Postmenopausal women can offset some of this effect by eating healthy and staying active. Statin medication to modify abnormal blood lipids may also be needed.

A study reported at the North American Menopause Society stated women after menopausal tend to weigh more, have larger waist lines, and a higher percentage of body fat than younger more active premenopausal women. Sedentary behavior correlated with a larger waist size – no surprise. But their findings showed regular exercise brought benefit to both pre- and post-menopausal women. When women increased their daily exercise – energy, mobility, and bone density all improved, along with reduction in waist size. Increased activity and weight control can also reduce the risk of developing Type 2 diabetes.

Last year, a journal of the American Association for Cancer Research reported a four year study examining women who walked the equivalent of thirty minutes per day had a lower risk of invasive breast cancer. The exact mechanism is unknown, but we do know exercise carries many positive benefits. Researchers stressed the benefit of lowered risk of invasive breast cancer was lost when exercise stopped — so daily exercise is key.

Walking daily can become a positive routine and is as important to overall health as brushing your teeth. Dogs love to walk. Our dogs provide encouragement to take a hike even in the rain. If you don’t have a dog, find a friend to join you. Exercise and social relationships correlate with happiness and longer life. Find a route that makes you smile and take a daily walk.

Some good advice from Dr. Seuss:
You have brains in your head.
You have feet in your shoes.
You can steer yourself in any direction you choose.

20151018_142608Betty and Bev

Broken Heart Syndrome

Takotsubo Cardiomyopathy

broken heartLosing a loved one, the sudden stress of receiving bad news, intense fear or domestic violence can break your heart. But this isn’t in the emotional sense we usually think about. There is an acute heart problem seen primarily in women of menopausal age in which the heart weakens in the face of sudden stress. The main pumping chamber of the heart balloons instead of contracts. Resulting chest pain and shortness of breath are symptoms indistinguishable from a heart attack.

The electrocardiogram shows classic ST segment elevation found in heart attacks. InSTEMI addition, there is often a small sharp rise in troponin, a heart injury blood marker. In a typical heart attack caused by a blocked coronary artery, the damaged heart muscle cells leak troponin, but usually in larger amounts.

If an angiogram determines there is a blocked artery the cardiologist will likely place a stent. But in the broken heart syndrome known as Takotsubo Cardiomyopathy, instead of finding blockage, the coronary arteries are clear — the results indicate a failing heart with an odd shape. It looks like an octopus trap (a tako-tsubo).

Takotsobu

The actual cause of this disorder is not known but is likely related to a surge of stress hormones that stun the heart and prevent normal muscle contraction. Takotsubo is usually seen in older estrogen-deficient menopausal women. However, younger women who lack estrogen because of surgical menopause from ovary removal are also at risk. Animal studies show estrogen appears to protect the heart in stress states.

There are no treatments shown to reverse Takotsubo. Doctors usually order common heart failure medications including beta blockers (to reduce heart rate and blood pressure), ACE inhibitors (to dilate arteries making it easier for the heart to pump) and diuretics (to remove excess fluid). It isn’t known if continuing the drugs can prevent a recurrence, but within two months, most patients fully recover. A few women are left with reduced heart function, and occasionally abnormal heart rhythms occur.

Women in this age group may also have underlying heart disease requiring medical management unrelated to the sudden stress state. Like men, women develop blockage of the major coronary arteries.

Another heart problem most often seen in women involves only small heart arteries. The largeHeart superficial vessels coronary arteries are clear but tiny arteriolar vessels are diseased. Microvascular disease is serious. It can lead to heart attacks and heart failure. A treadmill in combination with continuous monitoring, followed by echocardiogram to check heart function will show abnormalities. Microvascular disease is also treated medically.

YogaTechniques used to help reduce stress hormone surges include: progressive muscle relaxation, exercise, yoga, avoiding alcohol and caffeine. Controlling anxiety is not easy and counseling may be necessary.

 

Lipstick Logic
Betty Kuffel, MD

LOVE YOUR HEART

Two Red Hearts

Your Heart – Prevent and Reverse Heart Disease in Women, Men and Children

Kindle e-book $2.99   http://tinyurl.com/kindle-heart-sale          

Paperback $9.99  https://www.createspace.com/4330606

For the entire month of February, Your Heart is offered at sale rates.

American Heart Month is a perfect time to raise awareness and explore reversible risk factors for cardiovascular disease. Know your health history and address factors that can be modified to improve heart health:

♥ Tobacco use and cessation

♥ High blood pressure identification and treatment

♥ Cholesterol abnormalities paired with dietary modification and statin use when needed

♥ Obesity and diabetes with recommendations for normalizing weight and glucose

♥ Low activity levels counteracted with exercise prescriptions

♥ Alcohol consumption history and limitation of use

♥ Heredity factors and recommended interventions

Heart risk factors are within your ability to control. Make this the month you evaluate your personal risks and take action to reduce them. With the right knowledge and actions, the number one cause of death in women and men is preventable.

Book Excerpt:

Why is coronary artery disease the leading cause of death?

Atherosclerosis is a disease of affluence. In developed countries throughout the world where food is plentiful, coronary artery disease is the leading cause of death. We eat, not only because we feel hungry, we eat to pass time, we eat for enjoyment, and we munch mindlessly at social events. The fact is, we eat too much and it’s making us sick.

Coronary artery disease is tied to obesity. Food choices, portion sizes and exercise interplay, but the disease is more complex than any of these factors.

Statistics are boring to read and don’t mean much when they are without a face. But consider the fact that 50% of all people have high blood pressure, high cholesterol or smoke; all three factors cause heart disease. Many of us personally know someone with these problems. Is it you? A loved one? You have the ability to make healthy choices and improve your health by treating these factors.

Part of the high death rate from heart disease is due to a lack of education about the cause and what can be done to fight it. But even knowing sound health practices, many people do not follow them. In recent years, there has been a reduction in heart deaths through improved treatment, education and reduction of risk factors, but coronary artery disease still remains the leading cause of death.

Two programs to address education, diagnosis and treatment are: the Million Hearts initiative, developed by the Department of Health and Human Services, with a goal to prevent a million heart attacks and strokes by 2017; and the WISEWOMAN program, administered through the Centers for Disease Control and Prevention.

Heart disease is a huge problem in developed countries around the world, including the United States. The Million Hearts program joined with the US Centers for Disease Control and Prevention, the American Heart Association and other organizations. Together they share strategies to reduce heart risk factors and save lives. Information from these organizations is available for education programs to implement change.

At 21 US sites, the WISEWOMAN project provides a screening and evaluation program to help women obtain healthcare when they have little or no insurance. Examinations, laboratory tests and education to lower risks are included.

Diabetes, overweight, poor diet choices, low physical activity and excess alcohol are all issues placing people at risk. If any of these affect you, take control, read more, learn more and make heart healthy changes. Don’t become a statistic. Take action. Choose to reduce your personal risk factors.

According to the US Centers for Disease Control and Prevention, 50% of men and 64% of women who die suddenly of coronary heart disease have no previous symptoms. Even if you have no symptoms, you may still be at risk for heart disease.

Katie, a registered nurse who believed she was healthy, working full time in a hospital but having difficulty with an arthritic knee finally decided to see an orthopedist. He recommended a total knee replacement procedure. As part of her preoperative evaluation, her primary physician evaluated her and performed an electrocardiogram. The electrical tracing of her heart conduction and rhythm was abnormal, indicating ischemia. A special nuclear medicine test of her heart showed marked reduction of circulation in the heart muscle. Katie went directly to the heart cath lab where two main coronary arteries were found to be more than 90% blocked by cholesterol plaques. The cardiologist dilated and stented both arteries. The orthopedic surgery had to be placed on hold. — Katie denies ever having any symptoms related to her heart.

Many people are aware that high cholesterol is associated with heart attacks, yet have never had a cholesterol blood test done. Because they have no symptoms, they can’t believe they might be a candidate for a heart attack. The more you know how lifestyle, food choices and heredity factors impact heart health, the more equipped you will be to make healthy choices and obtain proper healthcare. This section provides more information on risk factors.

 Thanks for stopping by. We hope 2014 will be a healthy and happy year for you.

Betty and Bev

HEART DISEASE IN WOMEN

Go Red for Women – Wear Red on February 7th

wb051305In 2003, the American Heart Association began National Wear Red Day®. With so many women dying each year from heart disease, this movement was formed to bring attention to the problem. Their goal was to educate women and reduce this statistic.

 For the past ten years, each February, the Go Red for Women events have raised awareness and helped women make strides against heart disease. Fewer women are dying from coronary artery disease now, but it still remains the number one threat.

 In support of women’s heart health, Lipstick Logic is providing free excerpts and a sale on our book for the month of February.

 This is a perfect gift for yourself and those you love.

Your Heart – Prevent and Reverse Heart Disease in Women, Men and Children

Kindle e-book $2.99   http://tinyurl.com/kindle-heart-sale          

Paperback $9.99  https://www.createspace.com/4330606

  Your Heart Book Cover- Final FINAL

 Chapter 5

Female Heart Disease

Women and Heart Disease

Many women do not realize they are at high risk for heart disease and early death. Under age 50, heart attacks in women are twice as likely to be fatal as in men. Each year more than 250,000 women die of heart attacks. Six times the number of women die from heart disease than from breast cancer. Many factors weigh into these statistics including hormones.

♥ Research reported in the National Institutes of Health bulletin, The Heart Truth for Women, states that by leading a healthy lifestyle, women can lower risks by 82%. You are in charge. This means: regular exercise, healthy weight and not smoking. Also take medications to control other risk factors such as high blood pressure and high cholesterol. What you choose to do and what you eat can improve health and prolong life.

Coronary Microvascular Disease

Early in life, male and female hearts look alike and act the same. With aging, gender differences in disease processes become apparent and contribute to misdiagnosis in women. Men typically develop arterial heart disease that narrows large coronary arteries on the heart surface. Women have the same type of large vessel disease as men, but are also prone to coronary microvascular disease — a problem involving the small vessels called arterioles.

Possibly triggered by inflammatory disorders, coronary arterioles in women become stiff and unable to supply adequate oxygen to the heart muscle. Chest discomfort and other symptoms more subtle are often associated with increased activity. Microvascular disease increases your risk for heart attack and sudden death.

A number of health problems cause inflammation including high blood glucose, smoking and chronic infection that also affect men. Additional factors in women are: poorly controlled premenopausal hypertension, anemia and autoimmune disorders*. All of these problems may contribute to developing coronary microvascular disease. However, the cause of this disease is unknown. The Women’s Ischemia Syndrome Evaluation study (the WISE study) provided extensive information for the disorder. Some researchers believe estrogen reduction is a related. Anyone can develop coronary microvascular disease, but inflammatory disorders appear to be a prominent factor and they are more common in women.

Special tests are required to diagnose coronary microvascular disease. Advanced disease may be present, placing the person at risk, yet a coronary angiogram — the best diagnostic evaluation for large coronary arteries — can be normal. If the clinical suspicion for heart disease is high and the angiogram is normal, a “Stress-Echo” is usually recommended to evaluate for microvascular disease.

Coronary microvascular disease cannot be treated with stents or a bypass, but medications and lifestyle changes are beneficial and life-prolonging. Treatment is similar to that used in large vessel coronary disease:

● Statins to lower cholesterol

● Low dose aspirin to inhibit platelets

● Nitroglycerine to relax and dilate arterioles to improve blood flow and treat chest discomfort

● ACE inhibitors to lower blood pressure

● Beta blockers to lower heart rate and reduce heart stress

● Heart healthy diet, daily exercise, no smoking, weight loss

Note: Autoimmune diseases occur when the body produces harmful antibodies against itself. Examples: Lupus, rheumatoid arthritis, psoriatic arthritis, multiple sclerosis, some thyroid diseases and many others.

More life-saving information like this can be found in Your Heart: Prevent & Reverse Heart Disease in Women, Men & Children

Thanks for stopping by.

Betty Kuffel, MD

Bev Erickson Co-author/Artist/Cover art

Cardiovascular Disease – Leading Cause of Death related to Childbirth

Heart Disease in Young Women

 Statistics from the state of California confirmed the leading cause of death related to childbirth is cardiovascular disease:

                ♥1/4 of women who died had some form of cardiovascular disease

                ♥2/3 of the deaths were related to cardiomyopathy (heart muscle weakness)

ct-x-heart-pregnancy-0220-em.jpg-20130218Only 6% of these women had been diagnosed with a heart problem prior to pregnancy. (American Heart Association Scientific Session report)

We think of pregnant women as healthy vibrant individuals who do well and have healthy babies. But, pregnancy is a high risk condition for many reasons. Pregnancy places a large cardiovascular load on a woman’s body.

Young women without underlying heart disease are better prepared to tolerate the stress of pregnancy than older women. However many women are now delaying planned pregnancies until an older age when the potential for heart disease has increased.

Lifestyle, including food choices, alcohol consumption, and tobacco use all impact health during pregnancy. Obesity and Type 2 diabetes also increase risk to mother and infant. Cigarette smoking increases risk for sudden infant death and women who smoke are also more likely to suffer sudden death.

Two conditions often seen with pregnancy are: high blood pressure (pre-eclampsia) and diabetes (gestational diabetes). Both require careful monitoring and treatment Women with these problems during pregnancy are more likely to develop high blood pressure, diabetes and cardiovascular disease later in life.

Being overweight and pregnant places both mother and child at risk for cardiovascular disease and complications during delivery, including C-sections and anesthesia-related problems. Overweight pregnant women are more likely to have stillbirths, deliver prematurely and may have large infants making delivery difficult. Large babies are more likely to become obese in childhood.

Additional statistics: (From The American College of Obstetricians and Gynecologists)

  • Over one-third of women living in the US are obese
  • More than one-half of pregnant women are overweight or obese
  • 8% of reproductive-age women are extremely obese & at high risk for pregnancy complications

Guidelines for pregnancy weight gain are calculated based on the woman’s pre-pregnant BMI (Body Mass Index). Details are available on the American Congress of Obstetricians and Gynecologists website: www.acog.org  Search “Weight Gain During Pregnancy.”

 General guideline:

·         1.1 – 4.4 pounds in the first three months

·         1 pound/week during the last six months

·         The average total weight gain over all BMI ranges =  30 pounds

·         Low weight women: over 30 pounds may be acceptable

·         Obese women: gain only 11-20 pounds during the entire pregnancy

Nutrition counseling at all weights is very important to assure proper food choices and nutrition during pregnancy.

Before becoming pregnant, healthy choices, an active lifestyle (including daily exercise) and weight control are all important. Seek a full medical evaluation including laboratory studies before becoming pregnant. An exercise program and nutrition counseling will benefit mother and infant.

 

POST-MENOPAUSAL HORMONE THERAPY IS BACK!

Low Dose Estradiol (bioidentical estrogen) and Dermal Patches Show Benefit

SunFor those who have not experienced hot flashes or flushes, as they are sometimes called, they don’t sound like much of a problem. For most women, they aren’t. For me, someone who is often cold and wears wool socks to bed the year-round, it was a comfortable experience. I was warm enough for the first time in my life, except for experiencing the 108 degree temperatures on a Nevada desert.

The actual cause of vasomotor instability resulting from low estrogen is not fully understood and the problem is highly variable between women. Some are afflicted with numerous episodes each day associated with marked flushing, drenching sweats requiring clothing changes and faintness, while others barely notice the transition of waning hormones.

Women often seek medical care for hot flashes but it is the silent problems evolving without estrogen stimulation become important over time. Hot flashes tend to disappear while related heart disease and osteoporosis evolve causing problems in years to come.

Until about ten years ago, most women with menopausal symptoms were prescribed some form of hormone replacement. But results from the 2002 Women’s Health Initiative (WHI) and the Million Women Study (MWS) changed this practice. There was controversy and confusion among the experts, but in the end, the women lost when the consensus was that hormone replacement carried too much risk. The risks primarily included increased breast cancer, uterine cancer, strokes and blood clots.

Experts decided risks outweighed the benefits and recommended discontinuing hormone therapy. — Suddenly, hot flashes around the world contributed to global warming.

Breaking from the refusal to order hormone replacement for women, in June 2013 the British Menopause Society and Women’s Health Concern updated their guidelines. New recommendations are based on findings from a panel of experts that reanalyzed data from the WHI and MWS studies related to the specific hormones used. This time, when tracking the hormone options, they found low dose bioidentical estrogen, both oral and skin patch, carried less risk.

 Supporting Information

Another article just published in the Journal of the American Medical Association, JAMA, agrees with the use of bioidentical estrogen in hormonal replacement.  A joint University of Washington/Group Health study revealed women taking the generic estradiol had fewer vascular problems than those taking the equine estrogen preparation (Premarin). This difference may be related to clotting factors levels making blood clots more likely in women taking Premarin. Also the risk of having a heart attack was slightly higher in women using Premarin. No difference in stroke risk was seen.

Which Estrogen is Preferred?

There are many forms of estrogen and progesterone, both in oral, patch and cream forms. But estradiol is the same as that produced by the human ovaries. Premarin and other preparations are similar in effect but differ in chemical structure from estradiol. This new evaluation of the 2002 data showed the skin patch delivery of hormones appears most favorable.

 What About Other Risks?

Science evolves. Study outcomes change how we treat diseases. Hormone replacement surged from high utilization to stopping its use all together. Now the transition is back toward favorable aspects of low dose preparations. This is not to say, it is safe in all cases.

  • If you have had breast cancer, even the cell type without estrogen or progesterone receptors, you are probably not a candidate for hormones.
  • If you have had a stroke or venous blood clots in your legs or elsewhere, you would not likely be prescribed either estrogen or progesterone.

 The hormone progesterone is known to increase the risk of heart disease in women. Its use is to induce hormonal withdrawal bleeding and reduce the risk of uterine cancer in association with estrogen replacement in women who have a uterus. Estrogen can be used alone, without progesterone, following hysterectomy.

 If you are troubled with disabling hot flashes or marked bone loss (osteoporosis) you may be a candidate for estrogenHip X-ray replacement. You should discuss taking an FDA–approved bioidentical form of estrogen via skin patch with your physician.

 In my book, Your Heart – Prevent & Reverse Heart Disease, there is a chapter on women’s heart disease and the impact of menopause.  Additional favorable studies are noted reporting similar findings using low dose estrogen after menopause. One such study showed a significant reduction in heart disease with bone density improvements in women who took low dose estrogen.

 Note: “Bioidentical” is not the same as pharmacy-compounded estrogen products that are not standardized and may have variable potency.

 For more information on menopause check out: http://www.womenshealth.gov and my book at http://www.yourheartbook.com.

Betty Kuffel, MD

References:

SAGE Publications. Hormone replacement therapy: British Menopause Society and Women’s Health Concern release updated guidelines. ScienceDaily, 24 May 2013. Web. 2 Oct. 2013.

Nicholas L. Smith. Lower Risk of Cardiovascular Events in Postmenopausal Women Taking Oral Estradiol Compared With Oral Conjugated Equine Estrogens. JAMA Internal Medicine, 2013