During menopause, women gain an average of 10 to 15 pounds. The reason for this weight gain is the loss of estrogen and progesterone that occurs with menopause. These hormones play an important role in metabolism. The good news is that with bioidentical hormone replacement women lose an average of 10 to 15 pounds to offset the weight gain that occurs with menopause.
There are several reasons to get excited about weight loss. The reason that motivates many of my patients is cosmetic. If you are overweight you will look better when you lose weight. A main reason this is attractive is because you will look healthier. The main reason I get excited when my patients lose weight is that they become much healthier. That extra fat is associated with many diseases, including heart disease, diabetes and cancer. By losing weight you feel great and you dramatically improve your health. It’s often a wonderful feeling to hear “Did you lose weight? You look great!” On the inside you can feel great that you have increased your life expectancy and your health expectancy, which is the interval of years of good health you can expect from your healthy approach to life.
The two most-concerning aspects of menopause are that visceral fat is increased and bone density is decreased. The increase in visceral fat is very dangerous because it leads to increased inflammation of the body and leads to insulin resistance. The increased inflammation leads to heart disease and clogged arteries, while the insulin resistance could lead to diabetes. The decreased bone density leads to osteoporosis.
A great way to reduce the visceral fat is by taking estrogen. That is part of the reason that estrogen is so effective at reducing heart disease. Women who replace bioidentical estrogen (estradiol) have a 50-60 percent reduction in heart disease and cardiac events. In addition to reducing visceral fat, estradiol improves the lipid profile. Estradiol reduces total cholesterol and LDL cholesterol. This is the “bad” cholesterol that increases the risks of heart disease. Also, estradiol increases HDL cholesterol, which is the “good” cholesterol. Having a high HDL reduces the risk of heart disease. Estrogen and progesterone have both been shown to raise HDL cholesterol. The most-commonly used conventional treatment for lowering cholesterol is with statin drugs. However, reducing the cholesterol with a statin drug does not reduce the risk of heart disease or a cardiac event except for a mild reduction in risk for those at very high risk for heart disease. Also, there are numerous side effects of statin, including muscle pain and tiredness. On the other hand, women who take estradiol feel more energy and vitality while losing weight.
Osteoporosis has a very high prevalence among menopausal women. During menopause there is a precipitous decline in bone density for many women. Osteoporosis is painless unless a fracture results. Unfortunately, a hip fracture has a high mortality rate for women (18 percent in first year) and can be very disabling for the survivor, leading to nursing home placement. The most common treatment for osteoporosis is alendronate (Fosamax). This does not help grow bone. Rather, it slows the decline of bone. In contrast, estradiol actually helps grow bone. That is, those who take estradiol actually see their bone density increase. Thus, taking estradiol is one of the most effective ways to significantly reduce the risk of hip fracture.
Dementia deprives many from enjoying life, and as it progresses can lead to total dependency and even death. There are no effective treatments for dementia. There are medications that have been approved for Alzheimer’s disease. These have some benefits, again slowing down the progression but not reversing Alzheimer’s. However, very few treatments prevent Alzheimer’s. Estrogen prevents dementia. When women start estrogen early in menopause, the risk for Alzheimer’s dementia decreases between 30 and 70 percent, varying among studies but consistently showing benefit. The protective benefit of estrogen for dementia when starting estrogen later is less dramatic but it still helps cognitive function.
There are several concerns that women have about starting hormone replacement. The biggest fear is breast cancer. However, women need to know that bioidentical hormone replacement does not increase the risk of breast cancer. It is unfortunate that women avoid bioidentical hormones because of this irrational fear. Part of the confusion is because people (including doctors) associate hormone replacement with the pharmaceutical products Premarin, a horse-based version of estrogen, and Provera, a synthetic version of progesterone. Bioidentical progesterone and synthetic Provera have opposite effects. Progesterone protects against breast cancer and heart disease, while those who take Provera have increased risk for breast cancer and heart disease. Progesterone is a mood enhancer and great for sleep, while the side effects of Provera include irritability, depression and insomnia. Bioidentical estradiol significantly reduces the risk of disease, while Premarin can dislodge clots in women who have plaque in their arteries. Despite these stark differences, many physicians and even many review studies conflate Provera and progesterone. This confusion harms women by depriving them of accurate information that would help them clearly see the benefits of bioidentical hormones.
With bioidentical hormone replacement, women have improved mood and sleep better. They also feel more energy and vitality. Sexual health is also improved with increased libido and improved lubrication. In other words, women who take bioidentical hormones feel great while losing weight. That is awesome, but from my perspective, what is even better is that you will have greatly reduced risk of heart disease, greatly reduced risk of a life-threatening hip fracture and reduced risk of dementia. It is my hope that women take advantage of this opportunity to feel great while losing weight and to improve their overall health!
To learn more, you can check out my website, njhormones.com. On my home page is a podcast that goes into more details about hormone replacement.
By Warren Slaten, M.D.
Dr. Slaten is a wellness physician specializing in regenerative pain treatments and lifestyle counseling. He is certified in advanced bioidentical hormone replacement.
