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HWN Suggests

On 2nd thought, estrogen can help

Four years after federal researchers scared millions of women off hormone therapy with a study showing it was bad for their health, they backtracked Monday, saying new data suggest there is a window of opportunity in which estrogen is beneficial. Estrogen is heart-healthy if women start taking it at or around menopause–precisely the time most women need it to relieve their hot flashes, the researchers reported in the latest paper from the Women’s Health Initiative, a huge, government-funded study. The hormone was found to be harmful only for women who wait until after 60, when they probably have some incipient cardiovascular disease already. The flip-flop, which may leave women scratching their…

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 The FDA Is Removing Black Box Warnings On Hormone Therapy For Menopause—Here's What That Means For You

However, while systemic therapy is also largely considered safe, there can be nuances depending on the type of estrogen, the way it's given, and a woman's personal history, Dr. Streicher says, adding that some women still face some risks from hormone therapy, including those with a history of blood clots or breast cancer.

 When Women Initiate Estrogen Therapy Matters

Estrogen therapy has been shown to be one of the most effective and generally safe means for managing bothersome menopause symptoms. However, there is a lack of data regarding the impact of initiating hormone therapy in perimenopause in terms of longer-term health outcomes. A new retrospective cohort analysis based on data from more than 120 million patient records aimed to compare the impact of menopausal estrogen therapy when started during perimenopause or after menopause or not at all. Specifically, the study looked at breast cancer, heart attack and stroke rates associated with estrogen therapy. The findings revealed that perimenopausal women who had used estrogen within 10 years prior to menopause had no significantly higher associated rates of breast cancer, heart attack and stroke compared to the other two groups. These findings highlight the potential benefit of earlier initiation of estrogen therapy during perimenopause for minimizing risk and optimizing long-term health outcomes.

Articles of Interest

A Brief History of Treating Menopause

How estrogen therapy got a bad name — and why doctors now say it shouldn't have.

Could Perimenopausal Estrogen Prevent Breast Cancer? Exploring the Differential Effects of Estrogen-Only Versus Combined Hormone Replacement Therapy

Traditionally, it has been thought that estrogens could play an important role in the pathophysiology of breast cancer, firstly because the female breast contains an abundance of estrogen receptors, and secondly because of the observation that estrogens can aggravate estrogen receptor-positive breast cancer

Estradiol HRT

Estradiol is a medication used to manage and treat postmenopausal symptoms and for women who have had hysterectomies. Estradiol is the most potent estrogen (E2) in the human body.

Estrogen Controversy

The evolving history of estrogen replacement. The latest studies are showing that hormone therapy (HT), if used during the peri-menopausal years only (in women under age 60), reduces risk of osteoporosis, hot flashes, night sweats, mood instability, coronary heart disease, and total mortality. Risks of HT include a slightly increased risk of venous clotting, stroke, and breast cancer. (Journal of Menopause, 2012) So what now for you? Should you take estrogen? Should you take estrogen with progesterone? What about “bio-identicals”? (A little known fact is that many prescription hormones are already “bio-identical”.)

Estrogen-Only Hormone Therapy Deemed Safe

Back in 2002, millions of women were left in the lurch when the findings of a groundbreaking Women's Health Initiative study showed that taking hormone replacement therapy could increase the risk of heart attack, stroke or breast cancer. Their choice: Stop HRT, and let the dramatic symptoms of menopause return, or risk serious problems but sidestep menopausal discomfort. Now, after the release of a follow-up analysis of the WHI data, women may be relieved to learn the findings: Estrogen-only hormone replacement therapy probably won't help women's hearts, but it might not harm them, either.

Everything You Need To Know About Estriol Cream

Estriol is the weakest form of estrogen.The body makes estriol during pregnancy (to help the uterus grow and stay healthy), but it’s undetectable most other times. And while no one is suggesting that you trick your body into thinking there’s a baby on board, estriol can be used during the years leading up to and following menopause in a topical cream. Different versions of topical estrogen cream can be applied vaginally or onto your facial skin. The result? Skin that’s healthier and better lubricated, wherever you use it.

I am on a twice-weekly estradiol patch along with oral progesterone nightly. My friend says that estrogen is dangerous in menopause. What can I say to my friend?

Finally, there is no evidence that transdermal estradiol in menopause causes breast cancer or breast cancer recurrence for those who are breast cancer survivors. Why would such a low level of estradiol work? It seems that the small group of neurons in the hypothalamus, called KNDy neurons (kisspeptin, neurokinin B, and dynorphin), which initiate reproduction, body heat management, and energy expenditure, are highly sensitive to estradiol, even at very low levels (De Tassigny, 2010, and Ebzieva, 2019). Most recently, the American College of Obstetricians and Gynecologists and The North American Menopause Society have supported the use of a small, pea-sized amount of vaginal estradiol to reverse vaginal dryness and pain on intercourse (Petridis, 2017). In summary, HRT replenishes natural hormones lost in menopause and at significantly lower levels than are generated throughout the many years of menstruation. This information may help your friend understand how disinformation about estrogen in menopause works against women.

Is the Estrogen Controversy Over? Deconstructing the Women's Health Initiative Study: A Critical Evaluation of the Evidence

The Women's Health Initiative (WHI) hormone trials have been widely interpreted as demonstrating that combined menopausal hormone therapy (HT) fails to protect against—and may increase—cardiovascular disease (CVD), stroke, and dementia in menopausal women, regardless of whether initiated early in the menopause or later. This conclusion does not agree with results of large epidemiological studies showing protection by HT and by estrogen replacement alone (ET) against CVD and dementia. One possible reason for this inconsistency is that the epidemiologic data are confounded by “healthy user bias.” Another possible explanation is that most women in the observational studies initiated ET or HT at or near the menopausal transition, at which point there is little or no arterial injury, whereas, in the WHI studies, older women, averaging approximately 12 years postmenopausal, many of whom would have had significant asymptomatic atherosclerosis, were treated.

It’s Time to Rethink Hormone Therapy for Women, Says Heart Health Scientist

“Hormone therapy has gotten a bad rap,” Hodis says. “It is important to appreciate that adverse outcomes reported from the Women’s Health Initiative for hormone replacement therapy—breast cancer, blood clotting—are rare events, especially when women start the therapy close to menopause. Without proper context, the misperceptions have far outpaced reality.”

Oral estrogen-only use riskier than patch or vaginal cream for menopausal women, study says

People taking estrogen-only pills during menopause were 14% more likely to be diagnosed with high blood pressure than those using estrogen-only patches, the study found. When compared to people using estrogen-only vaginal creams or suppositories, those taking the hormone orally were 19% more likely to diagnosed with hypertension.

Over-the-Counter Estrogen: Why Prescription Wins

Estrogen supplements come in various forms, ranging from readily available over-the-counter remedies to personalized prescription regimens. While the appeal of quick fixes can be tempting, it's crucial to consider the broader implications of these choices. Prescription treatments, backed by extensive research and customized to meet individual needs, stand as the optimal choice for estrogen supplementation. Choosing these therapies not only helps manage symptoms but also reflects a commitment to overall well-being, safety, and an informed approach to navigating menopause. Take this brief menopause quiz today to find out if prescription HRT is right for you. Winona’s specialized doctors will review results to offer personalized guidance.

The Controversial History of Hormone Replacement Therapy

Although most of the evidence obtained was only with oral conjugated estrogen with or without medroxyprogesterone acetate, further studies and analyses have consolidated the view that HRT is highly beneficial when given to symptomatic women within 10 years since the onset of menopause or to symptomatic women that are under 60 years of age. However, the damage remains, and low HRT use, which is unjustified, continues to occur throughout the world.

The Estrogen Controversy

Most people would agree that one of the most important pieces of medical news in 2002 was the announcement that hormone replacement therapies in women cause more harm than good. Any postmenopausal women who have not had a hysterectomy, however, should not receive estrogen only, as there is an unquestionable increased risk of endometrial, breast, and ovarian cancer.

The Pill Or The Patch? Are All Estrogens The Same?

It seems that when Premarin® is ingested as a pill, it is absorbed in the gut and then passes through the liver. This “first pass” in the liver produces a range of other steroids, but also may increase the risk of clotting. Some have proposed that this “first pass” through the liver alters the balance of prostacycline (a vasodilator) and thromboxane A2 (a vasoconstrictor) or reduces the effectiveness of protein C to keep blood fluid. In contrast, transdermal estrogen patches, which were first studied in 1997, deliver pure estradiol slowly through the skin that is then absorbed directly into the bloodstream. Because of this slow, steady, delivery rate, mimicking to some extent how the ovaries functioned during reproductive years, a lower sustained estrogen dose achieves equivalent biologic effects as those of higher dose estrogen pills.

The Ultimate Guide To Estrogen Patch Benefits For Menopause

Hormone replacement patches, also called estrogen patches, are one form of hormone replacement therapy (HRT) that has been proven to be effective at managing many of the more frustrating symptoms of menopause. While there are several different types of HRT, you may hear about it as a pill or a patch first

Transdermal vs. Oral Estrogen

Prescribing the right form of estrogen should be considered on an individual basis. Older women (age>60) that have never taken oral estrogen are advised to take transdermal estrogen to avoid the risk of myocardial infarction or stroke. Additionally, transdermal estrogen is the best choice for women that have a history of clotting disorders. For women that do not have these established factors, oral estradiol is the best choice for protecting the heart from cardiovascular disease and hypertension risks that increase dramatically in menopausal women.

Types of Estrogen Hormone Therapy to Consider

Even after you've decided to take estrogen replacement therapy (ERT), the decision-making isn't over. There are many types of estrogen therapy in many different forms -- pills, patches, suppositories, and more. The best type of hormone replacement therapy (HRT) depends on your health, your symptoms, personal preference, and what you need to get out of treatment. For example, if you still have your uterus, then estrogen will be given in combination with the hormone progestin.

Vaginal Estrogen Safe for Women With Breast Cancer

The researchers found that there was no increase in the risk of dying from breast cancer between women who used vaginal estrogen and women who didn’t use vaginal estrogen or systemic HRT. When the researchers looked only at women diagnosed with hormone receptor-positive breast cancer, the results were the same: using vaginal estrogen didn’t increase the risk of dying from breast cancer.

What Are the Pros and Cons of Different Types of Estrogen Replacement Therapy?

Once you have decided that you want to consider estrogen replacement therapy (ERT), there are more decisions to make on the horizon. Estrogen can be availed in different forms including pills, patches, and vaginal suppositories.

What Is Estradiol and Why Is It Important?

Estradiol medication is used by women to help reduce the symptoms of menopause with a decreased estrogen production. Undesirable symptoms include hot flashes, night sweats, and vaginal irritation or dryness. In turn, this impacts the body’s sexual functions as well as the health of other organs. Replacing the loss of estrogen in the body can also help to prevent osteoporosis and bone loss after menopause. For men, estradiol can be used to treat prostate cancer in certain instances by blocking the male reproductive hormones. Similarly, it can also be used at higher doses to treat some cases of breast cancer.

Resources

StatPearls

Estrogen therapy is a form of hormone replacement therapy used to manage symptoms associated with menopause, including vasomotor symptoms such as hot flashes and genitourinary syndrome of menopause, which encompasses vaginal dryness and dyspareunia. A decline in ovarian estrogen production during menopause contributes to these symptoms, significantly affecting quality of life. Estrogen therapy is administered alone in patients who have undergone hysterectomy, whereas patients with an intact uterus require combined estrogen-progestin therapy to prevent estrogen-induced endometrial hyperplasia.