Estrogen Replacement & Your Heart

Estrogens are the powerhouse of activity. You have estrogen receptors just about everywhere in your body--in fact, they are located throughout your brain, heart, blood vessels, bones, skin, intestines, and respiratory tract, as well as throughout your entire genitourinary system. They affect everything from the way your skin looks and feels to the way your heart beats.

Estradiol is the most active of the estrogens. It is mainly produced by the ovaries. As long as you are having menstrual cycles, it is your estradiol that is doing most of the ''estrogen work'' that is going on in your body.

Estrone, another of the estrogens, is the one most commonly found in increased amounts in postmenopausal women. It is usually not necessary to replace Estrone, as the body naturally produces it through the metabolism of Estradiol. The body derives it from the hormones that are stored in your body fat. Estrone does the same work that estradiol does, but it is considered weaker in its effects.

Estriol, the weakest of the estrogens, is produced in large amounts in pregnant women. Women who are not pregnant have small amounts of estriol in their bodies.

For many years, scientists have known that estogens are powerful and important for health and in the aging process, but as research continues, more and more benefits of estrogen are coming to light all the time. For example, researchers recently discovered that estrogen is a powerful antioxidant, able to protect the body from damage by free radicals. Free radicals are unstable compounds that can attack and damage healthy cells and tissues. Antioxidants prevent them from doing this.

In matters of the heart, there is conflicting information regarding estrogen therapy. Because of its antioxidant action, estrogen produced by a woman during her monthly cycle appears to help protect the linings of the arteries from free-radical damage, keeping them healthy, flexible and relaxed so blood can flow freely through them. Estrogen also increases the body's production of high-density lipoproteins (HDLs), the so-called ''good cholesterol'' that helps to remove low-density lipoproteins (LDLs), or ''bad cholesterol,'' from your system.

On the downside, estrogen can increase triglyceride levels. While low-dose hormone therapy therapy remains a therapeutic option for relief of menopause symptoms, the American Heart Association recommends that estrogens with or without progestins should not be used specifically for the prevention of cardiovascular disease, and The American College of Obstetricians and Gynecologists as well as the North American Menopause Society state that hormone replacement should not be initiated in women known to have coronary heart disease.

What is current research telling us?

A patient's age and existing cardiac risk factors appear to play a role in whether estrogen therapy will offer short- or long-term health benefits. Dr. Rhoda Cobin (Mount Sinai School of Medicine, New York), one of the authors of a statement released by the American Association of Endocrinologists (AACE), suggests that younger women who are close to menopause have less to fear from hormone replacement therapy than older women in terms of cardiovasular risk. "We think the data offer some reassurance to women close to the menopause, with the suggestion that estrogen supplementation may even protect against heart disease in these younger women. And even if it is not protective, it doesn't appear to be harmful so can probably be used safely to treat menopauseal symptoms. There does appear to be a window of opportunity for use of estrogen." Dr. Cobin goes on to say, "Each woman should be considered individually, and many factors should be taken into account when prescribing hormone therapy. These include age, time from menopause, other cardiovascular and thrombotic risks, and menopause symptoms."

With heart disease and stroke the leading cause of death and a major cause of disability to women world-wide, it is critical that research continue on this important women's health issue. A current study that researchers and healthcare providers are watching with interest is the Kronos Early Estrogen Prevention Study (KEEPS), a controlled, randomized, clinical trial that is recruiting 720 women to examine whether estrogen given orally (conjugated equine) or transdermally (skin patch) slows the rate of hardening of the arteries (atherosclerosis).

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