February 2008
Don't depend on hormones
The body’s production of a range of hormones declines with age. And since heart disease increases with age, it’s logical to
think that supplying the body with supplemental hormones, such as estrogen and testosterone, might help protect the heart.
Alas, this does not seem to be the case. In just a few short years, we’ve gone from the well-publicized hope that giving postmenopausal women supplemental estrogen would help prevent heart disease to the finding that doing so actually increases the risk of heart disease (along with the risk of stroke, breast cancer, blood clots in the legs, and dementia).
Here are the facts:
The old news is bad news
No woman should be taking estrogen or progesterone to lower her risk of heart attack or stroke.
Weigh the risks and benefits
Certain hormone supplements—notably estrogen, testosterone, and dehydroepiandrosterone (DHEA, a precursor of estrogen and testosterone)—do have benefits in some people. Estrogen has been documented to help dramatically with such symptoms and vaginal dryness and hot flashes—a recent survey found it much more effective than alternative remedies like black cohosh, soy supplements, and vitamin E—and it is FDA-approved for these uses.
Generally, however, the risks outweigh the benefits. The Women’s Health Initiative found that the increased risk of heart attack and blood clots began as early as the first year of hormone use. That means most women who use hormones to control symptoms do face some heart risk (as well as an increased risk of breast cancer).
As for testosterone: There is little evidence on testosterone therapy’s efficacy and safety. And there is even less evidence on the safety and benefits of DHEA.
Tread carefully with HRT
Our medical consultants advise avoiding DHEA entirely, taking testosterone only when a board-certified endocrinologist determines it’s clearly needed, and taking estrogen only short-term to treat specific health problems, such as severe menopause-related hot flashes.
If you’re a woman with severe menopausal symptoms that don’t improve with nondrug treatments, talk to your doctor about this approach:
Alas, this does not seem to be the case. In just a few short years, we’ve gone from the well-publicized hope that giving postmenopausal women supplemental estrogen would help prevent heart disease to the finding that doing so actually increases the risk of heart disease (along with the risk of stroke, breast cancer, blood clots in the legs, and dementia).
Here are the facts:
The old news is bad news
No woman should be taking estrogen or progesterone to lower her risk of heart attack or stroke.
Weigh the risks and benefits
Certain hormone supplements—notably estrogen, testosterone, and dehydroepiandrosterone (DHEA, a precursor of estrogen and testosterone)—do have benefits in some people. Estrogen has been documented to help dramatically with such symptoms and vaginal dryness and hot flashes—a recent survey found it much more effective than alternative remedies like black cohosh, soy supplements, and vitamin E—and it is FDA-approved for these uses.
Generally, however, the risks outweigh the benefits. The Women’s Health Initiative found that the increased risk of heart attack and blood clots began as early as the first year of hormone use. That means most women who use hormones to control symptoms do face some heart risk (as well as an increased risk of breast cancer).
As for testosterone: There is little evidence on testosterone therapy’s efficacy and safety. And there is even less evidence on the safety and benefits of DHEA.
Tread carefully with HRT
Our medical consultants advise avoiding DHEA entirely, taking testosterone only when a board-certified endocrinologist determines it’s clearly needed, and taking estrogen only short-term to treat specific health problems, such as severe menopause-related hot flashes.
If you’re a woman with severe menopausal symptoms that don’t improve with nondrug treatments, talk to your doctor about this approach:
- Begin with a low-dose regimen of estrogen
- If that works, an even lower dose can be tried; if it doesn’t, adjust upward slightly
- Try to stop the hormone pills at least annually, to see if symptoms have abated
- Use the pills for no more than three years unless symptoms remain severe
- If you suffer from vaginal dryness, consider a topical estrogen cream instead
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