Since the Women's Health Initiative (WHI) was published in 2002, doctors have believed that using estrogen, either alone or with a progestin, to treat the symptoms of menopause increased a woman's risk of stroke and heart attack. But a new study published in the March 2012 issue of the journal Menopause may have changed that generalization, at least a little.
The authors reviewed 151 earlier studies on women who went through menopause before the age of 50 and looked at their stroke and heart attack risk. The women in the studies were in menopause for many reasons -- some had their ovaries removed to prevent cancer or they might have had a benign tumor, or they could have been treated with chemotherapy or radiation that caused their ovaries to stop working and caused menopause before age 50, or they might have been a specific subgroup of women with premature menopause -- a medical condition that throws women into menopause before age 40.
The findings of this study are important. Here is why: Before the age of 50, estrogen protects women from stroke and heart attack -- the exact opposite of what the WHI study showed. For women between the ages of 50 to 59 years of age, oral estrogen at a dose equivalent to 0.625 mg/day seems to protect against heart disease but increases the risk of stroke. After age 60, estrogen seems to increase a woman's risk of stroke and heart attack.
This positive information about estrogen adds to a 2011 study in JAMA that showed women who have had their uterus out and therefore only need to take estrogen but not progestin do not have an increased risk of breast cancer. For a video about this study, click here.
Here is what this new study means for you. The decision to take estrogen or HRT must be an individualized one -- a conversation between you and your doctor that takes into account your risks, your age and your history. Prepare your questions before your visit and find out if estrogen is right for you, especially if you have had your uterus removed (hysterectomy) or if you are under the age of 50. I've made a video about this article below. For more information, visit my website, DoctorSeibel.com.
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