Cardiovascular health and the menopausal woman: the role of estrogen and when to begin and end hormone treatment

Abstract

Reports have correlated the use of estrogen for the treatment of menopausal symptoms with beneficial effects on the cardiovascular system. Molecular, biochemical, preclinical, and clinical studies have furnished a wealth of evidence in support of this outcome of estrogen action. The prospective randomized Women’s Health Initiative (WHI) and the Early Versus Late Intervention Trial (ELITE) showed that starting menopausal hormone treatment (MHT) within 5 to 10 years of menopause is fundamental to the success of estrogen’s cardioprotection in post-menopausal women without adverse effects. Age stratification of the WHI data has shown that starting hormone treatment within the first decade after menopause is both safe and effective, and the long-term WHI follow-up studies are supportive of cardioprotection. This is especially true in estrogen-treated women who underwent surgical menopause. A critique of the WHI and other relevant studies is presented, supporting that the timely use of estrogens protects against age- and hormone-related cardiovascular complications. Salutary long-term hormone treatment for menopausal symptoms and prevention of complications has been widely reported, but there are no prospective trials defining the correct length to continue MHT. At present, women undergoing premature menopause receive estrogen treatment (ET) until evidence of hormone-related complications intervenes. Normal women started on MHT who receive treatment for decades without hormone-related complications have been reported, and the WHI follow-up studies are promising of long-term post-treatment cardioprotection. A prevention-based holistic approach is proposed for timely and continuing MHT/ET administration as part of the general management of the menopausal woman. But this should be undertaken only with scheduled, annual patient visits including evaluations of cardiovascular status. Because of the continued occurrence of reproductive cancers well into older ages, these visits should include genital and breast cancer screening.

Association between Serum Uric Acid Level and ESRD or Death in a Korean Population

“… 41 Therefore, premenopausal females have low uric acid levels due to the action of estradiol. 42 Estrogen has cardioprotective effects 43 and beneficial effects on kidney disease progression by affecting TGF-β signaling, ECM accumulation, and renin-angiotensin system, which could make hypouricemia insignificant for all-cause mortality and ESRD in females. 44 …”

Studies to Elucidate the Effects of Furostanol Glycosides from Dioscorea deltoidea Cell Culture in a Rat Model of Endothelial Dysfunction

“…In a study involving 144,260 postmenopausal women, premature menopause (compared to the absence of premature menopause) was associated with a significantly increased risk of developing and progressing coronary heart disease, heart failure, aortic stenosis, mitral regurgitation, atrial fibrillation, ischemic stroke, peripheral artery disease, and venous thromboembolism. For natural premature menopause, the risk ratio was 1.36; for surgical premature menopause, the risk ratio was 1.87 [14,15].…”

“…In women, there is a progressive violation of endothelial function at all stages of menopause, which is partially associated with a decrease in estradiol level. The increased risk of cardiovascular disease in this group of women is primarily due to the reaction of tissues to a severe hypoestrogenic state in the absence of a physiological adaptation of the female body to new conditions [14,15].…”

“…According to Naftolin et al, without continuing efforts at improving the drug regimens and removing harmful agents and practices from menopausal health care, it is inevitable that there will be increased aggregate misery, cost, and societal impact of age-related ovarian failure. The findings discussed above should be a call to action to further the search for effective lifestyle regimens, educational programs, diagnostic methods, and hormonal and non-hormonal agents with which the increased rate of CVD in postmenopausal years can be confronted [15].…”

Menopause and the Skin: Old Favorites and New Innovations in Cosmeceuticals for Estrogen-Deficient Skin

“…MHT use is an individual issue for the woman and her caregiver. This applies to women with histories of successfully treated estrogen-sensitive lesions [70].…”