Sullivan, Mg. Study Links Estrogen Use to Improved Cognition. Family Practice News 2004 Feb 1

Overview

If yous're a 40-something woman, you probably have given hormone replacement therapy (HRT) at least a passing thought. As you get closer to menopause age (the average age for menopause is 51.4 years), you'll be giving more serious consideration to questions about HRT. When you reach menopause, will HRT be right for you?

A familiar favorite

As recently every bit 10 years ago, nearly every woman at menopause automatically got a prescription for estrogen or estrogen combined with progestin, another female hormone. Hormone replacement therapy was standard treatment to salve hot flashes, vaginal dryness, indisposition and other menopausal symptoms.

Estrogen and the cardiovascular system

Scientists are still learning near the actions of estrogen in the body. Studies have shown that estrogen affects almost every tissue or organ organisation, including the eye and blood vessels. Estrogen's known effects on the cardiovascular organization include a mix of positive and negative:

Increases HDL cholesterol (the practiced kind)
Decreases LDL cholesterol (the bad kind)
Promotes claret clot germination, and also causes some changes that have the reverse consequence
Relaxes, smooths and dilates blood vessels so blood flow increases
Soaks upwardly free radicals, naturally occurring particles in the blood that tin damage the arteries and other tissues.

Estrogen probably affects the cardiovascular system in other means that are as yet undiscovered. New research continues to requite scientists and physicians more information – and raise more questions about this important and controversial hormone.

Over the years, evidence was accumulating that suggested estrogen besides helped protect women confronting heart illness. With centre disease is the number one killer among women over historic period 65, this is an important issue. Women develop heart illness x years afterwards than men, but by age 65, their gamble is equal to that of men.

The accustomed thinking was that the drop in estrogen levels associated with menopause accounted for this bound in heart illness risk in women. When estrogen levels decline, levels of LDL cholesterol (the harmful kind) increase, and levels of HDL cholesterol (the positive kind) decrease, leading to the build up of fat and cholesterol in the arteries that contributes to eye assail and stroke. It made sense that replacing estrogen through HRT would potentially improve heart wellness. This thinking contributed to a huge rise in the number of women existence prescribed estrogen.

Rethinking old ideas

Contempo studies on the long-term apply of HRT are changing that fashion of thinking. With scientific data potentially linking HRT to higher risks of eye set on, stroke and other serious health bug, many women are reconsidering HRT.

The buzz about estrogen started in the late 1990s when a report from the Heart and Estrogen-Progestin Replacement Study (HERS) was published in the Journal of the American Medical Association (JAMA). This written report of more than 2,700 women with existing coronary eye disease was designed to test whether estrogen plus progestin would prevent a second heart assault.

During the first year of HRT, women in the study had a 50 percentage increase in heart attack and stroke. But, later on two years of handling, women on HRT actually had less heart affliction and fewer heart attacks and strokes compared with women not taking HRT.

The report left many unanswered questions, leading researchers to accept another expect at these same women. They published their results in 2002. This time around, after well-nigh three more than years of followup, the researchers concluded that there was no lasting decrease in eye disease or middle attack/stroke risk from HRT, and HRT increased the gamble of blood clots.

Evidence adding upwardly

Meanwhile, an even larger study, the Women's Health Initiative (WHI), was raising more questions virtually the potential risks associated with HRT. Involving more than 160,000 women, WHI is the earth's largest clinical trial of wellness interventions for midlife women, studying the effects HRT, diet changes and calcium and vitamin D supplements on eye illness, osteoporotic fractures and breast and colorectal cancer risk.

In 2002, scientists at the National Institutes of Health (NIH) National Middle, Lung and Blood Institute halted the arm of the WHI written report in which women were taking combination estrogen and progestin. Early information from this group of women showed that HRT significantly increased the chance of breast cancer, heart assail, stroke and claret clots in the legs and lungs.

Then, in 2004, the NIH stopped the estrogen-simply study arm, in which women who had undergone hysterectomy were taking estrogen. Data showed that estrogen increased their risk of blood clots and stroke and did not reduce the chance of centre attack. (Estrogen's effect on breast cancer risk was unclear.)

A alter in recommendations

These studies were the first large-scale trials that looked for cause and effect with centre illness and HRT. HRT does offer some benefits, such equally preventing osteoporosis and reducing the hazard of colon cancer. Simply the data on center-related risks from these studies were very compelling. As a event, the American Heart Association and the U.S. Food and Drug Administration adult new guidelines for the use of HRT:

HRT should not be used for prevention of heart attack or stroke.
Use of HRT for other bug such as preventing osteoporosis should exist carefully considered and the risks weighed against the benefits. Women who take existing coronary artery illness should consider other options.
HRT may exist used brusk-term to treat menopausal symptoms.
Long-term use is discouraged considering the chance for heart attack, stroke and breast cancer increases the longer HRT is used.

The bottom line, say physicians at the Miller Family Centre, Vascular & Thoracic Institute at Cleveland Clinic: weigh the benefits of HRT against the risks and discuss the whole subject of HRT with your physician to be able to make an informed decision.

Mail Menopausal Hormon Replacement Therapy

How prevalent is heart disease among women?

Female reproductive organs

Female person Reproductive Organs

Cardiovascular illness is NOT just a human's disease. Cardiovascular disease is the Number one killer of women over age 25 in the United States, regardless of race or ethnicity. Once a woman reaches the age of 50 (well-nigh the historic period of natural menopause), the risk for heart disease increases. In young women who accept undergone early or surgical menopause, the risk for eye affliction is besides higher, especially when combined with other chance factors such as:

Diabetes
Smoking
Loftier blood pressure
Elevated LDL (low density lipoproteins) cholesterol
Low HDL (high density lipoproteins) cholesterol, sometimes chosen "skillful" cholesterol
Obesity
Sedentary lifestyle
Family history of heart disease

What is menopause?

Menopause is a normal stage in a woman'southward life. The term menopause is unremarkably used to depict whatsoever of the changes a adult female experiences either before or after she stops menstruating. As menopause nears, the ovaries gradually produce less estrogen (a female hormone), causing changes in the menstrual bike and other physical changes. The most mutual symptoms of menopause are hot flashes, dark sweats, emotional changes and changes in the vagina (dryness and cloudburst or thinning of the vaginal walls).

Technically, menopause is the end of a woman's reproductive bike, when the ovaries no longer produce eggs and she has her concluding menstrual cycle. The diagnosis of menopause is non confirmed until a adult female has not had her menses for six to twelve consecutive months.

Menopause commonly occurs naturally in women between ages 45 and 55 . Still, loss of estrogen tin can also occur if the ovaries are removed during surgery or if a woman goes through early menopause.

How is eye disease associated with menopause?

Estrogen helps a younger adult female'south body protect her against heart disease.
Changes in the walls of the blood vessels, making it more probable for plaque and blood clots to course.
Changes in the level of lipids (fats) in the blood occur.
An increase in fibrinogen (a substance in the blood that helps the blood to clot). Increased levels of blood fibrinogen are related to heart disease and stroke.

What can be done to reduce the risk of heart affliction for menopausal women?

Offset and foremost, "traditional" hazard factors should exist addressed. Women with the lowest risk of heart disease are those who:

Avoid or quit smoking
Lose weight and/or maintain their ideal body weight
Participate in aerobic practice for 30-40 minutes, three to five times per week
Follow a diet low in saturated fatty (< 7% daily amount); low in trans-fat (partially hydrogenated fats such as margarine or shortening); and high in fiber, whole grains, legumes (such as beans and peas), fruits, vegetables, fish and folate-rich foods
Treat and control medical conditions such equally diabetes, loftier cholesterol and high claret pressure level that are known chance factors for eye disease

For many years, preliminary observational enquiry showed that HRT could possibly reduce the risk of middle disease in women. It appears that the reason why the observational studies showed women on hormone replacement therapy had less heart disease was probable due to the lifestyles of women who have hormone replacement therapy rather than the medical benefits.

More recent studies of women, such every bit the Center and Estrogen/progestin Replacement Written report (HERS) and the Women'south Health Initiative (WHI) concluded overall health risks exceeded the benefits provided by HRT. Women who participated in the WHI showed an increased risk for breast cancer, coronary heart affliction (including nonfatal heart attacks), stroke, blood clots and gall float disease. Based on the results of these studies, HRT is not indicated for cardiovascular hazard reduction. It should be noted that while 1 arm of the WHI study concluded (estrogen-progestin), other arms (such as estrogen lone) are ongoing. The American Middle Association states, "The loss of natural estrogen every bit women age may contribute to the higher risk of heart disease afterward menopause. Nevertheless, in light of recent results from clinical trials, the American Heart Association does not suggest women to accept postmenopausal hormone therapy (PHT, formerly called hormone replacement therapy or HRT) to reduce the risk of coronary heart disease or stroke."

There are other risks and benefits that come up from HRT. It is important to hash out the risks and benefits of HRT with your own physician before making a decision.

What exactly is HRT?

Hormone replacement therapy (HRT) is a treatment programme in which a woman takes estrogen with or without progestin (a synthetic form of progesterone). To decrease the risk of uterine cancer in women who have a uterus, progestin is usually prescribed with estrogen.

What are the benefits of HRT?

Benefits of hormone replacement therapy for postal service-menopausal women, include:

Increased elasticity of the blood vessels, allowing them to dilate (widen) and allow the blood flow more freely throughout the body
Improved curt-term symptoms of menopause such as hot flashes and mood swings, as well as vaginal dryness, dry out peel, sleeplessness and irritable bladder symptoms
Decreased risk of osteoporosis and fractures (cleaved bones)
Decreased incidence of colon cancer
Possible decreased incidence of Alzheimer's affliction
Possible improvement of glucose levels

Is HRT safe?

Short-term hormone replacement therapy is safe for most menopausal women who have HRT for symptom control. However, earlier HRT is prescribed, make sure you review your medical history with your health care provider. Together, you and your health care provider can decide if you lot have conditions or inherited health risks that would make HRT unsafe for you. HRT is not recommended for women who have:

History of prior heart assault or stroke and/or increased risk for vascular disease
Unexplained vaginal haemorrhage
Active or past breast cancer
Fibrocystic chest disease
Active liver disease
Endometrial cancer
Gall bladder disease
High risk for claret clots or a history of claret clots

What are the risks of HRT?

The wellness risks of HRT include:

Increased adventure of endometrial cancer (only when estrogen is taken without progestin) For women who accept had a hysterectomy (removal of the uterus), this is not a problem
Increased take a chance of breast cancer with long-term employ
Increased run a risk of cardiovascular disease (including eye set on)
Increase in inflammatory markers (such as C-reactive protein)
Increased risk of blood clots and stroke, especially during the first year of employ in susceptible women

All women taking hormone replacement therapy should have regular gynecological exams (including a PAP smear). The American Cancer Social club also recommends that women over age 50 should:

Perform breast self-examination once a calendar month
Have a breast concrete test by her health care provider once a year
Have a mammogram once a yr

What are the side effects of HRT?

Nearly 5 to x percent of women treated with HRT have side effects which may include chest tenderness, fluid memory and mood swings. In virtually cases, these side effects are mild and practise not require the woman to finish HRT therapy.

If you accept bothersome side effects from HRT, talk to your physician. He or she can often reduce these side furnishings past irresolute the type and dosage of estrogen and/or progestin.

If yous have a uterus and take progestin, monthly vaginal bleeding is likely to occur. If it will bother y'all to take your monthly menstrual cycle, discuss this with your health intendance provider.

Is HRT the same as birth control?

No. Although women who take nascency command pills are also taking estrogen and progestin, the outcome is not the same. Women who take birth control pills have not been through menopause and demand higher levels of hormones to prevent ovulation. HRT is non a high enough strength to cease ovulation.

Later menopause, estrogen levels are low and HRT is used at a depression dose to restore hormone levels to a more normal level.

How do I make up one's mind if HRT is correct for me?

Even the best candidates for HRT need to periodically evaluate if HRT is the correct treatment for them. Yous and your health care provider should discuss your medical history and risk factors, also as how HRT can be tailored to your needs.

Here are some questions you lot tin enquire yourself and discuss with your physician:

Am I experiencing difficult menopause symptoms?
Do I have whatever medical conditions or a family history of sure weather condition that might make HRT beneficial for me?
Do I have any medical atmospheric condition or a family history of certain conditions that might brand HRT riskier for me?
Have I considered alternatives to HRT?

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Source: https://my.clevelandclinic.org/health/articles/16979-estrogen--hormones