I’ve been asked this question many times.  Patients and family members have genuine concern, anxiety, worry and confusion about this topic.  Doctors have genuine concern, anxiety, worry and confusion about this topic.  What if there is a family history of breast cancer?  What if I have had breast cancer? What if my breast cancer was estrogen receptor positive or my family member was estrogen receptor positive? How can I protect against osteoporosis?  How can I best protect myself against heart disease?

If you are going through menopause,  or are post-menopausal it is very likely that you have concerns.  Remember that symptoms of menopause include hot flashes and night sweats, vaginal dryness, anxiety, mood swings, depression, panic attacks, back pain and more.  There are laboratory tests that your doctor can order and help determine your menopausal status.  With estrogen having over 400 functions in the body including increasing metabolic rate, improving insulin sensitivity, maintaining muscle and improving sleep as well as increasing blood flow, dilating small arteries and inhibiting platelet “stickiness”, it is likely that many of you will find it important to have this discussion with your health care provider.  There isn’t enough room in this blog to describe the good things that estrogen can do with respect to helping prevent osteoporosis.

Sarrel, P., et.al., “The mortality toll of estrogen avoidance: An analysis of excess deaths among hysterectomized women aged 50-59 years,” AMERICAN JOURNAL OF PUBLIC HEALTH 2013; July 18.

In the above study researchers estimated that between 18,600 and 91,600 postmenopausal women aged 50-59 who had had a hysterectomy may have died prematurely because they did not take estrogen.

Historically, the caution we physicians have with hormone replacement is legitimate  –  a very famous heart study that is still quoted to this day (over 70 years later) hinted at the adverse effects of oral estrogen with respect to increased heart disease.  According to the Journal of Clinical Endocrinology and Metabolism, May 2013 “the media attention surrounding the publication of the initial results of the Women’s Health Initiative (WHI) in 2002 led to fear and confusion regarding the use of hormonal therapy (HT) after menopause.  This led to a dramatic reduction in prescriptions for HT in the United States and around the world…..it has been argued that in the 10 years since WHI, many women have been denied HT, including those with severe symptoms, and that this has significantly disadvantaged a generation of women. Some reports have also suggested an increased rate of osteoporotic fractures since the WHI.”

We live in a fantastic age of computer literacy at the earliest of ages and up to the most seasoned adults.  We have internet search engines, high tech laboratory analysis of blood, saliva, urine, and genes. Physicians have at their disposal tools that can assess cardiovascular risk and peek at the density of your bones.   Ask questions. Think about the symptoms you have. Consider hormone replacement therapy and come to your care provider educated and knowing what questions you’d like answered.  Do your homework.  Know the difference between oral estrogens and estrogens that can be delivered through the skin. If you and your health care provider decide that hormone therapy is best for you,  decide if you would rather take an estrogen derived from pregnant mares or if you would prefer a hormone identical to the hormones you were born with.

Education is power.  Have the conversations.  There is no better feeling than to know that you are participating in the decisions around your medical care.  We know that patients that are informed and feel they are in partnership with their health care provider have better outcomes.

Until next time,  continue to stay away from processed foods (they can turn to ‘bad’ estrogen), eat at least 10 servings of vegetables a day and drink your water. Hint: we’ll be discussing detox and those ‘bad estrogens’ soon !!!!!!!!!!!!!!!!!!!