Suggested Reading: The Estrogen Dilemma

In case you missed, it, there was an excellent article, “The Estrogen Dilemma, in the New York Times Magazine this weekend. The author, Cynthia Gorney, recounted the emotional roller-coaster she experienced as a result of mid-life hormonal changes, but questioned the safety and long-term consequences of the hormone replacement therapy that seemed to put her back on an even keel.  In her own quest to find the answers, she interviewed the leading researchers and medical experts and learned the “inside story” of the Women’s Health Initiative Study, which caused thousands of women to abruptly stop taking Estrogen.  This is a “must-read” article for anyone considering whether or when to take estrogen replacement.  Here are a few of my own take-aways:

• The Women’s Health Initiative Study, the largest government-financed study of women’s health that linked hormone use with health problems, was deeply flawed. As one doctor put it, they tested “the wrong drugs” on the “wrong population.”  The study used estrogens made from the urine of a pregnant mare (sold as Premarin and Prempro by Wyeth) and enrolled women whose average age was 63 – a good ten years after their final menstrual period.  In short, the study wasn’t designed to answer the question of hormone safety in women just entering menopause.

• The estrogen used in transdermal patches (e.g. Vivelle-dot, Climara) is different from the estrogen used in the WHI study. As the author explains, “pharmaceutical estradiol comes from plants whose molecules have been “tweaked”  in labs until they are atom for atom identical to human estradiol, the most prominent of the estrogens pre-menopausal women produce naturally on their own.”  As Gorney further clarified online; “although there’s nothing that proves Premarin carries more risk, estradiol was the form preferred by all the researchers I talked to who either use estrogen or said (esp if they were men) that they’d have no problem using it.”

• The author reports that researchers are focusing on what they refer to as the “timing hypothesis – the proposition that estrogen could bring great benefit to a woman who start it in her 50s while having the reverse effect on a woman 10 years older.” Gorney writes that though this “timing hypothesis” is still experimental, scientists know there are ways estrogen improves and protects the brain when it is added to healthy tissue.  But the converse is true too. If estrogen is given to brain cells that are aged or otherwise damaged, it appears useless and can even be harmful. That is why the WHI also reported that hormones increase the risk for aging-related dementia. (remember, many of the test participants were aged 65 when they started the hormones).

• There is such a thing as “perimenopausal depression,” that can be set off by “ricocheting hormones.” Doctors seem quick to prescribe anti-depressants when often estrogen replacement will correct the hormone fluctuations that are causing the sudden onset of depression.

If you are considering whether or when to take hormones to alleviate perimenopausal symptoms including depression, sleep disorders, hot flashes and lack of focus or concentration, be sure to read this article for an explanation of HRT today.  You’ll be more informed and able to make a decision based on facts and unbiased thinking thanks to the reporting of Cynthia Gorney.  Tara Parker-Pope also writes about this article in her most recent blogpost, The Mental Chaos of Menopause, in the New York Times.  The comments left by readers are just as interesting.