It has been known for a long time that menopausal women who took estrogen did much better with regard to breast cancer that those who did not. The power of this information, from the largest menopausal randomized,controlled, double- blinded prospective trial of ever, is a reassuring 23% decrease in observed breast cancer cases in estrogen users compared to those women who took the placebo (dummy) pills. Note that these women had hysterectomies, took estrogen not paired with MPA, or Medroxy Progesterone Acetate, a synthetic progestin also called Provera. Not that the data for the combination are scary, just not as clearly positive as estrogen alone.
As women let’s keep our level heads. We must demand our care providers present evidence-based, not fear generating, information to guide the hormone decision (see Tara Parker Pope’s book, The Hormone Decision, 2007, Rodale Press). Logical, plausible, coherent information that integrates principles of basic physiology, observed clinical outcomes and wise hormonal relief of menopausal symptoms is available to every woman. Women have to look for it and be confident of the good well-documented information that exists.

Estrogen is a powerful antioxidant in breast tissue, blood vessels and acts favorably throughout the body. So it makes sense that the larger effect of estrogen will be health-enhancing in many organ systems, including the breast and cardiovascular systems.

It is also well known that “bad things happen” with respect to heart disease risk factors in women once estrogen levels fall. And heart-health enhancing effects of estrogen have been clearly shown for over 25 years in monkey models of menopause (Clarkson T Ref). All sorts of clinical studies have pointed to this important heart disease risk reducing power of early estrogen administration in menopause (called the timing hypothesis, (Hodis H ref).

The fact that some professional disagreement exists is not hard to explain, kind of like the two party system of government. Study design can be misleading and experts get invested in defending one trial over another. But the fact that reputable doctors still cling to old misconceptions is mystifying and disappointing. Starting hormones early in menopause (at least within the first ten years)allow us optimal disease risk reduction for virtually all systems examined closely. The facts are quite clear: women who do not take estrogen, as a group, suffer acceleration of disease risks (heart, bones, diabetes, loss of muscle mass, brain-neuron loss) after menopause. This the brutal biologic truth. Outliving natural evolutionary life spans places women at greater risk for diseases as we age as compared to men. (see “The Evolutionary Origin and Significance of Menopause,” in the journal, Menopause, Vol 18,number 3, pages 336-342, March 2011, by Pollycove R, Naftolin F, Simon, JA.) Men continue to produce ample amounts of estrogen (and testosterone, of course) well into their 80′s and 90′s! We are living longer and so now have the diseases of aging afflicting millions of women each year. Estrogen is not the fountain of youth. It won’t turn back the clock entirely. But it slows down the harmful effects of sustained low estrogen levels that accelerate aging processes of every organ system. For those women who have had a hysterectomy, as in this study, post menopausal estrogen is safe and can be easily tailored to meet each woman’s personal needs. And for those who still have their uterus, natural progesterone (often prescribed as Prometrium brand of micronized bioidentical FDA approved progesterone) or progesterone-like opposing progestin (such as Aygesten brand or Norethindrone generic)on a periodic basis, can be adjusted to each woman’s life style and estrogen dose required to feel her best and avoid menopausal symptoms.
For more comprehensive information, see Dr. Pollycove’s book, The Pocket Guide to Bioidentical Hormones, Alpha Press, 2010. Each organ system and symptom complex is addressed chapter by chapter, paying attention to your unique menopausal experience and goals for optimal health and quality of life. The better the information the greater will your confidence in making the right health-enhancing choice.

I have been up all night reading your new book and believe it is time for me to change what I am doing. I had a total hysterectomy last fall and have been taking Phyto B supplements (Bezweckin company) per my health care provider since the surgery. She feel that my hormones are in a state of readjustment and that the Phyto B is the thing to care for their “unsettledness”. I see thropugh your writings that there is so much more I can be doing and hence, give up the sleepless nights, edgy moods, sluggishness, and the blahs to name just a few of the many things I am feeling more and more. Please tell me if you have heard of Phyto B and what your take is on it. Thnak you for your time and thank you for writing such an informative, straightforward book. Cheryl Leach

If we look closely at why it is that women are so much more likely to get low bone density, oteoporosis and fractures as compared to men, we can understand a lot about evolutionary biology. Women and men require minimum levels of estrogen in their blood streams in order to keep minerals stored in bones. Women inherit a biology that has been selected for over millions of years of biologic evolution. And our biology is designed to mobilize nutrients from bones to enrich breast milk after giving birth. The hormone state that prevails after women deliver their babies is a very low estrogen one. This helps initiate lactation (breast feeding) and is great for nursing babies. The same low estrogen condition activates certain enzymes which mobilizes extra fat into mothers blood streams and this is then secreted into the milk, adding more calories for the nursing baby. Men do not breast feed (obviously!) and their estrogen level remains adequate throughout their entire lives to protect their bones from low-estrogen bone loss. (Men are fortunate to not have their gonadal hormone production organ (testes) fail as do womens’ ovaries.)

For the vast majority of evolutionary time humans did not live very long life spans. Average life expectancy in stone age cultures never made it past 32. In 1900 in the U.S. the average life expectancy was 49, so only half of women would even live to experience menopause. So these incredible mechanisms to allow robust breast feeding in human mammals did not lead to millions of disabling fractures until the last 50 years, with a life expectancy for women today being 80 years or more! 30 years of life without adequate estrogen levels to protect bone strength. Women simply did not live long enough to develop weak and fragile bones in the past.

For this reason among others, I believe estrogen is a necessary hormone for optimal quality of life with respect to bone health and vigorous old age in women. Good nutrition, active life style with both aerobic and weight-bearing exercise and a healthy hormone balance are key for women to live a vigorous good quality life with strong bones.

An in depth scientific paper about the hormonal similarities between lactation and menopause (authors Ricki Pollycove, MD, MS, James A Simon, MD, and Frederick Naftolin, MD) will be published in March, 2011, in the peer-reviewed journal, “Menopause”).

I, a 25 year taker of HRT, found your book profoundly gratifying. Do you know of anyone at Kaiser San Rafael who is up to speed on bioidentical hormones? My ob-gyn there has advised me to taper off my estratest and methylprogesterone, but after reading your book I am back on my old dosage. I’ve continued through all the admonitions resulting from the big study which you quoted as in the re-analysis more or less reversing the original findings because it seemed to be working well for me and I didn’t see any reason to change until he made the specific suggestion which I wasn’t very happy with. So, after that run-on sentence, I am very interested in exploring bioidenticals as a replacement for what I’m taking. Thanks for your very informative and enlightening and confirming book!

Cindy Valentine