A heartfelt message, estrogen replacement therapy: use it or lose it

Abstract

The issue of cardiovascular and cognitive health in women is complex. During the premenopausal phase of life women have healthy blood pressure (BP) levels that are lower than age-matched men and they have less cardiovascular disease. However, in the post-menopausal stage of life women's BP increases and they are increasingly susceptible to cardiovascular disease, cognitive impairments and dementia, exceeding the incidence in men. The major difference between pre- and post-menopausal women is the loss of estrogen. Thus, it seemed logical that post-menopausal estrogen replacement therapy, with or without a progestin, generally referred to as menopausal hormone treatment (MHT), would prevent these adverse sequelae. However, despite initially promising results, a major randomized clinical trial refuted the benefits of MHT leading to it falling from favor. However, reappraisal of this study in the framework of a "Critical Window", or "Timing Hypothesis" has changed our perspective on the benefit to risk ratio of MHT and this review discusses the historical, current and future approaches to MHT.

Impact of lignans in oilseed mix on gut microbiome composition and enterolignan production in younger healthy and premenopausal women: an in vitro pilot study

“…After activating these receptors, oestrogen can promote mitotic activity, neoplastic transformation and cellular proliferation. The abundance of intracellular ER receptors confirms the significance of oestrogen and explains the fluctuations of the main physiological parameters during the natural female cycle as well as the dramatic health changes that follow the general decline in oestrogen after the menopause, such as an increase of cardiovascular conditions, weight gain, breast-and colon cancers, osteoarthritis and memory loss in post-menopausal women [16][17][18]. Suggesting that enterolignans are able to ligate on ER-α, substituting endogenous oestrogen and potentially alleviating the symptoms of lowered oestrogen, it would be interesting to investigate the potential role of a diet high in enterolignan precursors together with the activity of the gut microbiota in premenopausal women.…”

Estrogen, brain structure, and cognition in postmenopausalwomen

“…Prescriptions for CEE fell abruptly (Kim et al, 2005) after negative reports from large multicenter trials showed equivocal effects or even increased risk of adverse health outcomes (Grady et al, 2002; Shumaker et al, 2003; Shumaker, Legault, Kuller, et al, 2004). More recently, however, studies began to re‐evaluate the possible benefits of HT including stress reduction, enhancement of cardiovascular health, improvement in cognitive performance, and a delay in the onset of dementia (Herrera, Hodis, Mack, & Mather, 2017; Merlo, Spampinato, & Sortino, 2017; Speth, D'Ambra, Ji, & Sandberg, 2018).…”

Early versus late initiation of GH replacement in adult-onset hypopituitarism

“…For the initiation of postmenopausal oestradiol replacement therapy (ERT), it is now generally accepted that timing is critical; the sooner oestrogen is started after menopause, the greater the benefits (26,27). These findings are presumed to be related to the health of the underlying tissue and/or to other factors such as downregulation of receptors (28,29).…”