VIDEO: Hormone therapy protects bone, heart, brain health during menopause
In this Healio Video Exclusive, Caroline T. Nguyen, MD, speaks with Donna Shoupe, MD, about the health benefits of menopausal hormone therapy for women.
Reductions in estrogen levels during menopause can result in several health changes for women, according to Shoupe, professor of obstetrics and gynecology and director of the women’s health center at the University of Southern California (USC) Keck School of Medicine. Shoupe details some of the benefits of menopausal HT and discusses the history of the Women’s Health Initiative studies with Nguyen, who is assistant professor of clinical medicine, obstetrics and gynecology in the division of endocrinology, diabetes and metabolism at the USC Keck School of Medicine, course director for the USC Jorge H. Mestman Endocrine and Women’s Health Symposium and and a Healio | Endocrine Today Editorial Board Member. Shoupe also highlights recent research that has revealed links between estrogen therapy and reduced risk for Alzheimer’s disease and dementia.
You can view the full video interview above or read the Q&A transcript below.
Editor’s note: This is a three-part Healio Video Exclusive series. Check out the other videos on CGM and Graves' disease.
Video transcript
Nguyen: Let’s start with the basics: What is menopause?
Shoupe: The official definition of menopause is the last bleeding episode, but there’s a special criteria: you have to wait a year, and then you are menopausal since that last period. That [definition] implied that there’s a sudden change in hormones, and you didn’t really have to worry before and then, if you wanted to use hormones, there are changes that are occurring.
Now we know that estrogen and testosterone levels start dramatically dropping [after age 40 years]. That leads to early bone changes that you can see if you look at one of the bone density charts, [after age 40 years] is where that curve downward sharply begins. The American Heart Association (AHA) has recognized it and has many papers on what it calls the menopause transition. That’s the new term we now use because it reflects that there are changes that occur way before that last period. A lot of women have perimenopausal symptoms and the AHA said that they can link changes in atherosclerosis due to the lowering of estrogen during the time when women in the transition start having hot flashes and mood changes. All those early perimenopausal symptoms are linked to lower estrogen, and that there are other physiological problems associated with it.
One of the more exciting areas is linking those hot flashes, mood changes and the fog that a lot of women have to changes in brain health. There are a lot of papers that have looked at women on estrogen compared to those who haven’t been on it. Women on estrogen have a bigger [age-matched] brain, and the longer they use it, they have protection from dementia.
The emphasis now is not on the last bleeding period, it’s really on this menopause transition, and all the important events that are occurring during that time.
Nguyen: This is so important because there’s a lot of patients and clinicians both who haven’t paid as much attention to this period, and it seems like it’s starting quite earlier than what most people think about when they think about menopause and the average age of 52 [years] in the U.S. I think that’s great that there’s a little more attention there now.
We’re hearing about menopause a lot more in social media and the media in general. Can you catch us up because it feels almost like the pendulum has swung a bit. Can you give us a little bit of a background on where we’ve come since the early 2000s?
Shoupe: The popularity of hormone replacement right before 2002 was pretty good. There was more research being done. There was great news that came from the government because they said, “You know, we just really haven’t studied women very much. We study men. Women are kind of hard [to study], they have menstrual periods, they get pregnant, they have menopause, so we’ll just study [men].” They did have some women in the studies, but it was really directed at men’s diseases, and most of the participants were men in the studies. [Researchers] just said, “Well, it happens in men, we’re just going to assume that it happens in women.” Since then, we found out that is often not the case, because women have a lot of different hormones and have a lot of differences to men.
The government said [they were] going to do this big study. It was great news to all of us, and they were going to do it on menopause, which was so needed. There were a lot of epidemiological trials showing women live longer, they have less heart disease, and they have less dementia if they start hormone replacement.
They had these two big studies, WHI-1 and WHI-2, with about 16,000 patients and 10,000 patients, [respectively], that they planned to go for many years. However, in 2002 there was a big press conference. ... Some of the researchers came out and said, “We’re stopping the study. Estrogen is basically poison. It causes heart disease, and it causes breast cancer.” To this day, many women are still affected by that and have a great fear that there’s a strong link between estrogen and breast cancer.
Shortly after the press conference, a few months later, they published the paper for WHI-1 in 2002 in JAMA. It showed statistically no change in breast cancer. ... When they did the statistical analysis, it just meant whatever study medication you were using had no impact on that particular outcome, and they also had no increase in heart disease.
Later on, they divided the study because the average age was 63 [years], it was an older population, we usually start [after age 50 years]. For the first time, which was wonderful, [researchers] discovered that it was the early initiation of hormones within the menopause transition where you get the best results, particularly [for] heart disease.
Then, WHI-2 was published, which showed no change in cardiovascular disease and no significant change in breast cancer. ... Since then, there has been a growing number of papers supporting the important protection that estrogen has for bone, CVD and the big one is brain function. A lot of papers [are] showing women on hormone replacement have larger brains, age-matched to women not on hormone replacement, and many show that the longer you use hormones, the lower your risk of Alzheimer’s [disease] and dementia. HT is strongly linked to protection from bone, heart and brain.
For more information:
Donna Shoupe, MD, will speak more about HT during menopause at the USC Jorge H. Mestman Endocrine and Pregnancy Symposium taking place in person and virtually March 1. Register for the symposium at https://keckusc.cloud-cme.com/course/courseoverview?P=0&EID=8796.
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