Ignore that rumbling sound, ladies; it's just all the guys running for the exits with strained looks on their faces. Geez, you'd think I said "menstruation" or something. Oh, well ... let's get on with one of the biggest midlife decisions all women must make: whether and how to take estrogen supplements when menopause approaches. Unfortunately, we can't even make a dent on the topic here, but you'll see my real purpose shortly.
Postmenopausal hormones -- including estrogen -- have significant, proven, well-defined benefits and risks, plus many lingering questions. Estrogen alone dramatically affects the cells of blood vessels, skin, bones, brain, liver, and all the delightful and functional parts that make women women. The lesser effects of waning estrogen production include raging hot flashes, aching joints, insomnia, and meteoric mood swings. (You do know why they called it "menopause", don't you? Because Mad Cow Disease was already taken.) Its more serious, yet common, effects include sexual dysfunction, heart attacks, and terminal hip fractures. Name your poison.
Synthetic estrogen was welcomed in the 1920s as a cure for most of those problems, until a decade later it was discovered to lead to endometrial cancer. In the '70s, the addition of progestin solved that problem, and the combination of estrogen and progestin remains the "cure" of choice for the effects of declining estrogen production. But estrogen still dramatically impacts the risks of other very serious diseases, some positively and some negatively. You must analyze and evaluate the tradeoffs according to your own circumstances, based on much more information than we can cover here.
The benefits of estrogen include relief of menopausal symptoms (big cheer from both the guys and the gals), lower risk of osteoporosis and its crippling effects, improved cholesterol profile and cardiovascular health, improved blood flow via several different mechanisms, probable lower risk of colon cancer, and maybe lower risk of Alzheimer's disease. That's all big stuff!
But estrogen also increases the risks of endometrial cancer, breast cancer, gallbladder disease, deep vein thrombosis with pulmonary embolism, ovarian cancer, and maybe asthma and lupus. The conflicts between estrogen's life-prolonging benefits and ultimately life-threatening risks mean that estrogen has a clear near-term benefit for many women but more murky long-term effects. As more data emerge from the relatively recent addition of progestin to estrogen therapy, the long-term picture will tend to clear up.
There are charts, chapters, and even whole books on the various types of estrogens, progestogens (such as progestin), and their combinations. You and your physician will need to apply that data to your own medical history and profile in the process of deciding your own hormone regimen. For example, a woman with a family or personal breast cancer history may want to avoid estrogen, but if the skeleton in her family or personal closet is colon cancer, estrogen will reduce her odds of getting it by 35 percent. Science is already exploring the means of tailoring your personal postmenopausal hormone therapy cocktail - or your cancer chemotherapy cocktail -- to your individual DNA profile to maximize the ratio of benefits to risks for your individual situation, but for now it's just not that "simple".
Doctors say the postmenopausal hormone question - whether, which, what form, how long - is one of the most complex, challenging, and overwhelming decisions their middle-aged female patients must make (outside the shoe store). Debates over obvious existing medical quandaries such as open heart surgery, amputation, chemo, or nursing home time almost resolve themselves at some point, as the patient's circumstances reach a critical stage. But letting the postmenopausal hormone therapy questions solve themselves is asking for an unnecessarily detrimental outcome. Most of the symptoms and effects of declining estrogen can be preempted or greatly mitigated through medical science. For now, the bottom line seems to be to read, study, ask, consult, decide, and act ... then revise your decision adaptively as your body responds and medical data keep rolling in.
An obvious copout? Of course. The decision should involve reading several books, consulting at length with at least one or two specialist physicians, discussing with your family its affects on your longevity and vitality, and a great deal of thinking ... not a three-minute read in an e-zine.
Fortunately -- and here is the real message of this month's column - a new, groundbreaking, authoritative, and still-evolving study and book have shed new light on this and many other life-affecting women's health issues. Every female old enough to comprehend the book should read it cover to cover. I recommend buying it for your near-adolescent daughters and literally home-schooling them in it if they need a push or aren't quite capable yet of understanding it unassisted. Why the rush? Because many health problems start in childhood, especially with dietary and exercise habits.
A sweeping recommendation? It's a sweeping study! In 1976, thousands of female nurses signed up to log their habits and health for the foreseeable future. The number of nurses (120,000 of them are still reporting data in depth), the number of years (25 and counting), and the subjects' conscientious participation (they're still contributing blood and tissue samples for medical analysis) have positioned this study right up there with the Framingham Heart Study in overall health study credibility, and as the gold standard in women's health studies. This book lays out how their habits are affecting them, and thus how your habits are likely to affect you. These data could potentially be as important as aspirin or penicillin, in my unqualified and simplistic guess, if every female made simple lifestyle changes based on the lessons of this study. 70-90% of the cases of women's most common fatal or debilitating diseases - including heart disease, diabetes, and several types of cancer -- could be prevented by healthier lifestyles. This would extend not only women's lives, but also their vitality during those longer lives.
Many other books address the postmenopausal hormone issue in greater depth, but the others don't also address a dozen other major women's health issues with such authority, simply because they are not based on such a large, lengthy, detailed study. This study and this book provide a solid knowledge base from which you can expand and evaluate your reading into specialized books on the individual topics most pertinent to your own circumstances.
The study is the Nurses' Health Study, the book is "Healthy Women, Healthy Lives" by Harvard Medical School, and every bookstore should have it now. At $26 ($18.20 if you purchase it through Seasoned Cooking), it's downright cheap considering its wealth of authoritative, current, applicable, statistically significant data and discussions. The first three chapters discuss the nature of the study and how to interpret its results. The next eleven chapters cover eleven specific diseases - such as diabetes, heart disease, and various types of cancer -- in a consistent format addressing risks, factors we can and cannot control, bottom lines, and steps we can take to lower our risks. The last ten chapters discuss behaviors - exercise, nutrition, smoking, birth control, alcohol consumption, etc. - including benefits, risks, bottom lines, and recommended lifestyle changes. These topics sound familiar; what's new is that the advice here is based on a huge volume of facts, not some guru's latest book-selling mantras or "mere" accepted medical theories. The toughest chapter is the one on interpreting risk statistics, Chapter 3. It can be glossed over if necessary for young readers.
Medical science has extended women's expected life span by 30 years in the last century, and whether they truly enjoy, or merely survive, those years is increasingly within their control. The process of strongly influencing the number and quality of those extra years begins before we become adolescents, especially in decisions such as nutrition, weight control, exercise, smoking, and drug use. Such life-threatening and quality-of-life-threatening problems as heart disease, diabetes, and breast cancer can be rooted in childhood habits, yet it's almost never too late to make life-improving changes.
Do yourself and your family a huge service: buy, study, and heed this book. It could easily add decades of health and vitality to your family's lives.