Estrogen In Early Menopause Saves Lives


In the June 21, 2007 issue of the New England Journal of Medicine a randomized study of  8.7 year duration the question was examined whether postmenopausal women following hysterectomy would have a higher risk with estrogen replacement therapy than controls who did not take estrogen therapy. The lead author was Dr. JoAnn E. Manson of Harvard Medical School and the method chosen to examine the heart disease risk was a CT of the heart to measure calcium  in plaque of coronary arteries.

Previous research had shown a good correlation of calcification of coronary arteries with the degree of hardening of coronary arteries as shown in this image.

Various doses of estrogen were used and overall there was a reduction of calcium scores in all of the groups ranging from 22% to 31% when the calcium scores of the estrogen treated patients were compared to the non treated controls. This translated into 36% to 64% less heart attack rates when the treated groups were compared to the controls not treated with estrogen.

Discussion regarding estrogen replacement therapy

The discussion regarding estrogen replacement therapy following menopause is not finished, but women can be reassured that the cardiovascular risk appears to not be as straight forward as research seemed to suggest in the recent past. There likely was a bias in these retrospective studies and the present prospective study is much stronger having been done over 8.7 years following randomization. As this study was done on patients who had previous hysterectomies, there is no concern about uterine cancer. Breast cancer risk was not examined in this study.

Estrogen In Early Menopause Saves Lives

Estrogen In Early Menopause Saves Lives

The authors concluded that low dose estrogen replacement with 0.625mg of conjugated estrogen (Premarin) appears to be safe and has the most beneficial effect on coronary artery health when taken between the ages of 50 and 59. However, the authors also cautioned that estrogen would have multiple effects and may have negative effects on the cardiovascular system in some other way.

Reference: N Engl. J Med. 2007;356:2591-2602


Comment on Nov. 18, 2012:  The real problem of this study is that the authors took the wrong “hormone replacement”, namely Premarin, which is a non-bioidentical estrogen concoction from horses, which translates into an ill fitting key. The human body’s estrogen receptors do not fit this “key”. The proper experimental set-up would have been to use bio-identical estrogen hormones, which are usually given as a cream and would be the perfect key for the human estrogen receptors. This would have to be balanced with bio-identical progesterone to achieve a balance the way it is in a younger woman. We know from other studies that this prolongs life by preventing coronary artery disease, prevents Alzheimer’s disease, prevents strokes and does not cause uterine cancer or breast cancer. Women on bio-identical hormone replacement also retain their normal sex drive.

See this chapter on menopause in the Net Health Book.


Suppression Of Estrogen Affects Cognitive Function

Female patients with gynecological problems such as fibroids and endometriosis can be treated with leuprolide acetate depot (LAD) or Lupron. LAD suppresses ovarian function and decreases estrogen to the levels of postmenopause. In menopause estrogen levels show a natural drop. In this group the estrogen levels were chemically suppressed. The patients ranged in the ages 25 to 40 years of age-all of them well before the age of menopause. The researchers were able to observe the effects of estrogen on cognitive function without the brain changes associated with normal aging.
Dr. Barbara Sherwin, PhD, professor for psychology and obstetrics at Mc Gill University in Montreal stated that previous research has shown a connection between decreased estrogen and the deterioration of verbal memory. Taking estrogen during menopause can prevent this deterioration. The current study also showed a significant decrease in working memory and scores regarding mood in the women who are taking LAD.
Dr. Sherwin suggested also that some research points to a window of opportunity around the time of menopause where estrogen will protect.

Suppression Of Estrogen Affects Cognitive Function

Effects of estrogen (=E2) on the brain

But beyond that time, such as at the age of 65 or older, estrogen treatment does not provide these benefits. As shown in the Women’s Health Initiative study it may be detrimental.

Reference: The Medical Post, August, 22, 2006, page 45

Comment on Nov. 13, 2012:   There is a big difference between conventional hormone replacement therapy (HRT) and replacement of hormones with bio-identical hormones. The former (HRT) is what was proven by the Women’s Health Initiative study to be detrimental to postmenopausal women; the latter (bio-identical hormone replacement) is what a lot of European women have done for decades and what has benefitted them tremendously without side-effects whatsoever. Inform yourself and read more about treatment of menopause under this link (Nethealthbook).

Last edited December 6, 2012