There is a lot of confusion about the effects of estrogen replacement for menopausal women. It is understandable why this confusion exists. There is a paradox that I am going to explain that leads to the confusion.
If someone has a high level of estrogen in their body, they are at a high risk for heart disease and breast cancer. However, if a postmenopausal woman takes estrogen, her risk of heart disease decreases significantly and even her risk of breast cancer decreases. That is the paradox. If you understand this paradox, you will have a better understanding about estrogen than most physicians.
The paradox will be better understood when you know why someone has a high level of estrogen in their body. It is common knowledge that the ovaries produce estrogen. There are other cells in the body that produce estrogen, specifically fat cells, or medically known as adipose tissue. Unfortunately, the most common form of estrogen produced by the fat cells is estrone. This is an inflammatory form of estrogen. Also, the fat cells produce many chemicals that produce significant inflammation in the body. This inflammation is the root of many diseases in the Western world, including heart disease, diabetes mellitus and many cancers. In other words, the more fat that you have, especially visceral fat, which is the fat around the organs, the more likely you are going to have increased inflammation in your body. That puts you at greater risk for all of these chronic diseases.
Basically, someone with more fat will have more inflammation in their body and is at much higher risk for all of these diseases. They will also have higher levels of estrogen because as noted, the large amount of fat produces a large amount of estrogen. So then when you look at people’s blood work, those with higher levels of estrogen will have more diseases that negatively affect one’s lifespan. It is not the excess estrogen that is causing these diseases. It is the increased inflammation that is produced by the same adipose tissue. So, these high levels of estrogen will correlate with many diseases but the estrogen is not the cause of these diseases. Someone who does not understand correlation is not causation will think that the high levels of estrogen that correlate with these diseases is causing these diseases. But, estrogen is not the cause of these diseases.
Rather, the cause of these diseases including heart disease and cancer is the increased visceral fat that produces inflammation. Estrogen is produced by the same fat cells but is not the cause of those diseases.
So now let’s look at what happens when you give estrogen to a menopausal woman. Estrogen has multiple effects that reduce the risk of heart disease. Estrogen improves metabolism. Women will notice the effects of losing estrogen at menopause because on average, women gain 10-15 pounds around that time. I assure you that it is not usually muscle that they are gaining. They are producing more fat because their metabolism is slowed down. So, even if they don’t change their diet, they will start gaining weight. The underlying cause of that weight gain is decreased metabolism from loss of estrogen.
On the flip side of that weight gain, women lose 10-15 pounds when they start bioidentical hormone replacement after menopause. The good news is that the weight loss is achieved through the loss of visceral fat. As noted above, visceral fat creates a lot of inflammation that leads to those terrible diseases. By reducing visceral fat, the risk of those diseases is significantly decreased. Studies have shown that the risk of heart disease is decreased by 2-2.5 times with taking bioidentical hormone replacement. So if the risk of heart disease without taking bioidentical hormone replacement is 1, the risk of heart disease when taking bioidentical hormone replacement is 0.4-0.5. Considering that heart disease is the number one killer of older women, that is a great reduction in the risk of a potentially deadly disease.
Interestingly, many women are apprehensive about taking estrogen after menopause because they fear breast cancer. They are surprised to learn that estrogen actually reduces the risk of breast cancer. That is because estrogen, as noted above, reduces visceral fat. We talked about how visceral fat causes so much inflammation in the body. Besides causing heart disease by making the blood vessels sticky so clots can form, this inflammation also creates an unhealthy environment in tissues so cancer can form. This occurs in the breast or any other body tissue. That is why estrogen reduces the risk of breast cancer and other cancers including colon cancer. Visceral fat is reduced so inflammation is decreased and the body becomes healthier.
Also, estrogen actually increases bone density decreasing the risk of osteoporosis and accompanying fractures. This is especially important because of the high risk of death after a hip fracture. Estrogen also is protective against Alzheimer’s disease, especially when starting hormone replacement in the early years of menopause. Women who take estrogen for more than 10 years have significantly reduced incidence of dementia. So heart disease, osteoporosis and dementia, which are the three leading causes of death in women over 70 are all greatly reduced with hormone replacement.
Women who take bioidentical hormone replacement therapy (BHRT) feel more energy and vitality while losing weight. Bioidentical hormones are the same ones that your body produces including estrogen and progesterone. With BHRT, women have improved mood and sleep better. Sexual health is also revitalized with increased libido. Those benefits are accompanied by overall improvement of health.
Now you understand the paradox. The higher the estrogen level, the higher the risk of heart disease and cancer. That is because the excess fat in the body produces the excess estrogen. But start taking bioidentical estradiol and you will start to reduce that fat and thereby improve your health.
Estrogen is commonly prescribed in combination with progesterone. Another cause of confusion is that the pharmaceutical version of progesterone called Provera is a synthetic drug that has some of the opposite effects of the beneficial progesterone. For example, progesterone is protective against heart disease while Provera negates some of estrogen’s cardiac benefits. Progesterone has positive effects of mood while Provera causes irritability and anxiety.
With regard to breast cancer, progesterone is anti-proliferative and thus protects against cancer. In a large pharmaceutical hormone study (WHI study in 2004), Provera showed a mild increased risk of breast cancer. It should be noted that over time, this increased risk attenuated and there was no increased risk of advanced deadly cancers. Nonetheless, that one finding which did not maintain significance over time, has led to the conclusion that Provera may cause breast cancer. Unfortunately, many doctors confuse pharmaceutical Provera, which has many side effects, with bioidentical progesterone that has many beneficial effects including improving sleep and improving mood. Also, progesterone is protective against cancer.
Similarly, progesterone protects uterine tissue. Estrogen without progesterone causes proliferation of uterine tissue, which increases the risk of uterine cancer. Fortunately, progesterone protects uterine tissue so when taking a combination of bioidentical estrogen and progesterone, there is no increased risk of uterine cancer. It is very important to take oral progesterone rather than using a progesterone cream so the protective levels of progesterone can be reached. Thus, the beneficial effects of hormones are achieved while the breast and uterus are protected. The good news is that most women who take progesterone feel improved mood with better sleep.
So by taking bioidentical hormones there is no increased risk of cancer while there are many health benefits including better heart health, better bone health, better brain health and overall feeling great while losing weight. Understanding the literature and the distinction between synthetic and bioidentical hormones is key to understanding the risks and benefits.
Dr. Slaten is a wellness physician specializing in regenerative pain treatments and lifestyle counseling. He is certified in advanced bioidentical hormone replacement. You can learn more on his website, njhormones.com.
