Plummeting estrogen levels can change your health in surprising ways. Find out more to be better prepared for menopause.
When menopause sets in and estrogen levels go into decline, the imperviousness of your bones, heart, energy levels, and libido goes down, too.
And while replacing estrogen and/or progesterone with synthetic hormones can alleviate some of these symptoms, many women are hesitant to start hormone replacement therapy (HRT) because of studies indicating that HRT may increase the risk for developing such conditions as heart disease and cancer.
According to the Institute of Medicine (IOM), however, those studies also show that risk declines after you stop taking HRT. In fact, some data suggest that former users’ risk is comparable to that of never users within four years after discontinuing therapy.
“If you’re in your 50s and healthy, being on estrogen for four or five years can help you manage symptoms, and it may also improve your health profile,” says Geoffrey Redmond, MD, director of the Hormone Center of New York and author of It’s Your Hormones. “But if you’re 70 and haven’t been on HRT before, this therapy could instead raise your risk for developing certain conditions.”
Assessing Your Health Risks and the Role of HRT
The IOM recommends against routine use of HRT but says women should confer with their doctors to determine the best course of treatment based on their individual risk factors and preferences. The information below, however, may help you take a clear look at the possibilities offered by HRT vis-à-vis the health conditions that post-menopausal women are at increased risk for developing:
- Heart Disease: “If you initiate HRT within about one year of developing menopausal symptoms, it’s actually cardio-protective,” says Anne Ford, MD, Ob-Gyn at Duke University Medical Center. Other studies suggest, however, that estrogen is beneficial only if you have healthy arteries; if your arteries are already clogged (a common issue for women over age 60), estrogen may do more harm than good. Research also indicates that prolonged or later use of HRT may cause an overall increase in heart disease risk.
- Breast and Uterine Cancer: Rising estrogen levels increase the risk of breast, endometrial, and uterine cancer, which may be a concern for women who choose to take HRT. If you have a family history of any of these cancers, HRT may still be an option, but only when other approaches for managing menopause symptoms fail.
- Osteoporosis: Because estrogen circulating in your body helps control bone loss, losing estrogen means losing bone mass. The best way to prevent osteoporosis: Reach peak bone mass before menopause begins by exercising regularly (weight training is key) and consuming a healthy diet rich in calcium, vitamin D, and magnesium.
- Sexual Dysfunction: During menopause, the structure of the vagina physically changes. Tissues become thinner, more delicate, and less elastic — and that can make sex uncomfortable, even with appropriate lubrication. “Regardless of your libido, if sex is painful for you over time, you’re not going to want to have it,” says Ford. The good news: Treating the problem with topical estrogens can reduce vaginal atrophy and relieve dryness, which can have a dramatic impact on your quality of life.
The Bottom Line: Finding the Right Balance
Managing the hormonal fluctuations that take place during menopause can be quite a challenge. Too little estrogen may increase the risk of osteoporosis and possibly some forms of heart disease, but too much estrogen may increase your risk of breast, uterine, and endometrial cancer. Reaching an appropriate balance — with the help of your healthcare provider — is key to menopausal health and wellbeing.