Are you afraid that estrogen could increase your risk of heart attack, blood clots and stroke? If so, read on; this article is for you.
Over the past decade, fear has reduced the number of menopausal women who take estrogen from ~ 40% to ~ 15%. Although estrogen is a very effective medication for many of the symptoms of menopause, like all medications, even over the counter ones, there is always the worry of a potential complication.
The worry about estrogen escalated in 2002 with the publication of the Women’s Health Initiative (WHI), a study that found hormone replacement therapy (HRT) with the estrogen Premarin combined with a progesterone-type hormone called medroxyprogesterone caused women in menopause a higher risk of breast cancer, stroke, heart attack and blood clots.
In April of 2011, another study from the WHI came out that received much less attention. In that study, 10,739 postmenopausal women who took estrogen (Premarin) only without the medroxyprogesterone for an average of 5.9 years did not have increased risk of stroke, heart attack or blood clots.
There were design flaws in both Women’s Health Initiative studies
There were design flaws in both WHI studies. Finally, 10 years after the first one, a new report presented at this year’s annual meeting of the North American Menopause Society (NAMS) updated the WHI find-ings with a new study called KEEPS (KRONOS Early Estrogen Prevention Study). Here are the key points.
The WHI studies evaluated estrogen in women aged 60 to 79. That is almost ten years older than the age of women who are entering menopause. The new KEEPS study looked at the impact of starting estrogen on women just as they entered or within 3 years of entering menopause – on average about age 52 (50 to 59).
The results should make women feel much safer. Women who took either the oral estrogen Premarin at a dose of 0.45 mg daily or an estrogen skin patch (transdermal) at a dose of 0.05mg were compared to women of the same age who took a placebo. The women on estrogen appeared to be no more likely to have a stroke or heart attack than the women who did not take estrogen.
While taking estrogen wasn’t statistically safer than not taking it, it also didn’t put the women at higher risk. This really reinforced the 2011 estrogen only arm of the WHI study.
The KEEPS study determined risk by finding no narrowing of the wom-en’s carotid (neck) arteries and by finding no increased calcium depos- its in the women’s coronary (heart) arteries – increased coronary artery calcium is associated with increased risk of heart attack. Women taking estrogen tended to have lower coronary artery calcium. It seems that if women start taking their estrogen early in menopause, they are not adding to their risk of heart attack and stroke. Starting after age 60 may not be as safe.
The age at which you begin estrogen seems a very important part of your decision
Other good news is that estrogen started near menopause seems to be helpful for sexual function, improving arousal, desire, lubrication and orgasm. Transdermal estrogen takers had even better improvement in sexual function than those taking oral estrogen.
This is all great news for women in perimenopause and early menopause when many of the symptoms like hot flashes are happening. The age at which you begin estrogen seems a very important part of your decision. To help you better understand estrogen treatment, click here for a free ebook on how to take estrogen.
