Tag Archives: Estrogen replacement

ESTROGEN IS BACK IN THE NEWS

Estrogen Supplements May Reduce Dementia Risks

Two 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 Guelph 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

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POST-MENOPAUSAL HORMONE THERAPY IS BACK!

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

For 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 estrogen 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