By: Shelagh McNally for Body1One of the biggest disappointments of HRT (hormone replacement therapy) was that it actually didn’t prevent heart disease in menopausal women. New research is suggesting that the problem has been with the timing of HRT: It is being given too late.
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Protect Your Future Health: Are you Perimenopausal?
Most women first notice the first signs of menopause in their mid-40s but perimenopause can start as early as the mid-30s. Recognizing signs of diminished estrogen is the key to getting early treatment.
Uncomfortable, dry intercourse
Continual urinary tract infections
Urinary incontinence
Decreased fertility
Loss of libido
Increase in body fat
Loss of collagen in your skin
Loss of bone mass
Changing cholesterol levels
Hot flashes
Mood swings
What you can do
Adopt a low-fat, high-fiber diet rich in fruits, vegetables and whole grains.
Regular exercise of 30 minutes a day.
Stress reduction. Yoga, meditation and other stress reduction techniques can help.
Stop smoking. Perimenopause occurs one to two years earlier in women who smoke.
Ask your doctor to do some hormone blood work to determine your levels.
Consult your doctor about HRT or other hormone alternatives.
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Traditionally, women have been considered virtually immune from heart disease until after menopause, once estrogen levels drop dramatically. But new animal research conducted at Wake Forest University Baptist Medical Center is showing that we need to pay attention to heart disease and osteoporisis at least 5 to 10 years earlier, during perimenopause. “Research in animals suggests that the five years before menopause are when bone is lost and when heart vessel disease begins to accelerate,” said Jay Kaplan, Ph.D., head of the section of comparative medicine at Wake Forest and principal researcher for the study. “Waiting until menopause is not the time to start thinking about prevention.”
Kaplan’s animal studies showed that heart disease often starts prior to menopause. By studying a group of monkeys he found that stress in the younger years reduces estrogen levels leading to a buildup of fatty deposits well before menopause. Treating the estrogen-deficient monkeys slowed the growth of atherosclerosis but was only effective if the disease had not already started pointing to the “window of opportunity” when women would start HRT.
“Our research adds to the growing body of evidence that cardiovascular health after menopause is influenced by hormone levels many years earlier," said Kaplan. “Our monkey studies showed that a deficiency of estrogen before menopause places these females on a high-risk trajectory, even if they got estrogen treatment after menopause.”
Kronos Longevity Research is currently testing this theory of “window effective hormone therapy” with a five-year study evaluating perimenopausal women ages 45 to 54 receiving estrogen through oral tablets, a skin patch as well as a placebo.
Kaplan is also studying the effect of stress on the quality of ovarian function in the premenopausal period. “Ovarian function varies quite a bit during the perimenopause years,” Kaplan said. “And it turns out that reproductive function in both women and monkeys is easily impaired by stress.” During this research Kaplan witnessed how the subordinate monkeys were subject to high stress levels because the dominant monkeys harassed them. Subordinate monkeys had more stress, lower estrogen and reduced fertility levels. Stress levels in the modern woman are very similar and Kaplan warned that many women might not even realize their ovarian function is impaired because they still may cycle normally. “Often women won't realize there's a problem unless they're having trouble becoming pregnant or sustaining a pregnancy, he said. “But that means these women are being exposed to varying levels of estrogen, which can have an effect on your heart and bone health.”
The good news is that stress can be reduced and estrogen loss is reversible – if treated early on. But now is the time to start preparing for menopause. According to Dr. Steven Goldstein, an obstetrician/gynecologist at New York University Medical Center, and author of “Could It Be Perimenopause,” “Perimenopause is an excellent opportunity to begin a self-assessment and medical report card. Develop a plan with your doctor for your overall health, diet and lifestyle for the second half of your life. Perimenopause is a critical time in women's health.”
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