To learn more about hormone replacement and balancing for women, please click here: Female Hormone Replacement.
Frequently I am asked about hormone safety by patients interested in hormone replacement therapy (HRT), which typically includes estrogens (usually a combination of estradiol+estriol), progesterone, and testosterone since these are the hormones that are lost or significantly decline after menopause. I reassure them that the bioidentical hormones I prescribe are both safe and effective when prescribed properly by an experienced physician. This has been shown in many large studies, some in the US and others in Europe. I am then often asked, “how long should I stay on these hormones?” In some cases their primary doctor or gynecologist has told them to stop using hormones after a period of time, perhaps 5 years. I point out that there is no good evidence that stopping bioidentical hormones is a good idea, as doing so will accelerate cognitive decline, dementia, cardiovascular disease, weight gain, loss of bone mass, as well as ruin sexual function and libido and skin appearance. In my view, with proper monitoring, they can continue the use of their HRT as long as they wish to. My oldest current woman patient receiving HRT is 88 years old and she is fit and healthy! Another just turned 80 and is a national champion powerlifter! She did her first pull-up at 78 and has kept on getting stronger every year.  In my practice, the use of HRT improves cognitive function, increases bone density, improves the skin appearance, maintains or builds normal muscle mass, helps with weight loss, improves mood and memory, and boosts libido. Pretty good results from one treatment!
However, as more research is done on the use of hormones such as bioidentical estrogens to treat menopause, we are discovering benefits beyond those we already knew. For example, several recent studies have linked estrogen use to longevity in women and some of these studies tell us why this may be so.
A study of 8,801 women, followed for 22 years, published in 2006, titled “Increased longevity in older users of postmenopausal estrogen therapy:the Leisure World Cohort Study” showed that women who were long term users of estrogen died at a 10% lower rate per year than women who did not use estrogen. Their average age at death was 88 years old, much older than the average American female lifespan. The effect was particularly striking in women who had used estrogen therapy for over 15 years.
There have been some conflicting studies on cardiovascular effects of estrogens. It is important to separate out bioidentical estradiol from synthetics. The bioidenticals are beneficial while the synthetics are not and can even be harmful. Here is a report that explains that using hormone replacement therapy after menopause cuts the rate of heart attacks in half! Clearly, reducing the rate of dying from the number one killer in the US will increase longevity.
There is strong evidence that estrogens (and progesterone) induce antioxidant enzymes and longevity genes that protect our cells from free-radical damage and activate cellular repair; by doing so they improve many areas of health such as preserving muscle mass and reducing inflammation. Commonly my menopausal women patients will tell me their joints no longer hurt or feel stiff after starting estrogen treatment. Estrogens ability to maintain skeletal muscle mass helps keep women strong and avoid age-related frailty leading to falls.
Heres another paper which reviewed 23 relevant studies showing that the bioidentical hormone estradiol is the estrogen responsible for this beneficial effect on muscle mass.
How about brain health?
My experience having treated thousands of menopausal women is that estrogens clearly improve memory, particularly difficulty in remembering words and also improve focus and concentration. Studies done on women who did not yet have cognitive impairment or dementia have shown that taking estrogen delays the onset of dementia significantly. Unfortunately, once dementia has developed it may be too late; estrogens given to dementia patients did not improve the disease. The bottom line: start your estrogen therapy as soon as possible after menopause to maximize the cognitive benefit and prevent or delay dementia as much as possible.
So, these are some of the articles your primary care doctor and even your gynecologist may not have read or heard of. For some reason, these positive studies don’t make the nightly news. When we hear studies on hormones, they are often negative, taken out of context, or they are not referring to bioidentical hormones. There is a great difference between the positive effects of natural and effective estrogens (estradiol and estriol) vs synthetic hormone alternatives. The synthetic versions often do have adverse effects and should be avoided.
Thanks for reading this and I am always happy to discuss these and any other articles with my patients,
Dr. Kaye
