Estrogen, Breast Cancer, and Your Heart

by Dr. Stephen Sinatra
Filed Under: Women's Health
Last Reviewed 02/06/2014

A woman's perspective on weathering the estrogen changes that are part of menopause and making smart choices about hormone replacement therapy, written by Jan Sinatra, Dr. Sinatra's wife and a long-time cardiac care nurse

When women enter menopause, they never really know what lies ahead—a light breeze or a torrential downpour.

Thankfully, I only had “light showers.” I experienced some insomnia, but I never had the intense hot flashes that many women do. Instead, I had something more along the lines of nocturnal “warm rushes” that would drive me to fling off the bed covers and then pull them back on soon after. Some friends told me they were changing linens and pajamas nightly, so I thought I was doing pretty well by comparison. I was more annoyed by weight management, mental fog, and remembering what I did with my car keys.

Even though I felt I was navigating the change pretty well with dietary interventions like flaxseed and soybeans, it was Dr. Sinatra who tactfully suggested that some form of hormone replacement might be in order. He could handle my nocturnal symptoms, but the subtle mood swings and irritability were tougher for him to live with. Some days he didn’t know which wife he was coming home to.

We first checked my hormone levels through saliva testing. We were amazed to find that my estrogen level was within normal limits. It was my progesterone level that was in the basement. Dr. Sinatra suggested using a natural progesterone cream, which made life easier for both of us.

A few years later, though, my hormone levels changed and I began needing estrogen replacement. While I was pretty much symptom-free by then, my gynecologist insisted that I take low doses of synthetic estrogen and the drug Prometrium (a form of progesterone) for “cardio protection.” I did, but only for a few months.

Dr. Sinatra and I had started researching the hormone chapter for our book Heart Sense for Women at the time, and we made a decision to go with bioidentical hormones after reviewing the latest studies and interviewing experts in the field.

The point I want to make here is that if the medically trained wife of a cardiologist and anti-aging doctor finds it challenging to make good decisions about hormone replacement, then it must be a minefield for most women.

A Stark Choice: Heart Health or Cancer Prevention?

As a cardiac rehab nurse, I’m well versed in the heart-protective effects that estrogen has for women. And in the 1980s and 1990s, those benefits created a real dilemma for women who had to decide whether to undergo estrogen replacement therapy.

On one hand, it was thought that estrogen replacement therapy could lower a woman’s risk for heart disease—but on the other, it could increase her risk for breast cancer. For women who had a history of both, the decision was really tricky. We were basically being asked to trade presumed cardio protection for cancer prevention.

Then the bottom fell out: Large-scale studies showed not only that estrogen replacement therapy failed to confer the cardio protection we’d anticipated, but that all of conventional hormone replacement therapies (meaning the drugs formed by combining unnatural estrogens and progesterone-like compounds called progestins) were highly problematic.

These developments naturally led to widespread interest in the only available alternative—bioidentical hormones, which are made from plants and are identical in chemical structure to the hormones produced by your own body.

Risks of Conventional HRT

Unlike bioidentical hormones, the conventional approach to hormone replacement therapy relies on synthetic and animal-based products that are not structurally identical to your own hormones. Most of you have heard of Premarin, an hormone replacement therapy mainstay that derives its name from its source: pregnant mares’ urine. Now, while you can call this source “natural” for a horse, it’s absolutely foreign to a woman’s body.

Although these products can be effective in helping a woman maintain her estrogen levels, they have a downside.

Synthetic estrogen, whether in birth control pills or hormone replacement therapy, has been associated with an increased risk for blood clots, pulmonary embolisms, heart attack and stroke. There are further concerns that they can increase the risk of breast cancer—especially the hormone-dependent kind—because they enhance proliferation of cells in the breast.

Progestins such as medroxyprogesterone acetate (Provera) are another big problem. In one large case-control study of 3,345 women between the ages of 50 and 74, those taking estrogen and/or progestin had a significant increase in their risk for breast cancer.

Another large study reported a substantial increase in heart attack and stroke among women taking both Provera and Premarin.

One reason for this is that Provera and other progestins offset the protective effects that estrogen has on blood lipids, and they lower “good” HDL cholesterol—an important marker of cardiovascular health. Natural progesterone, on the other hand, maintains and enhances the favorable effects that estrogen has on blood lipids.

Dr. Sinatra’s clinical experience with hormone replacement therapy has been alarming. Years ago he encountered so many problems caused by Provera—hypertensive crises, leaking heart valves, refractory chest pain, clots, and breast cancer—that he warned every woman in his practice flat out to not take it. He was shocked that other cardiologists appeared blind to this connection—just as they are today when it comes to the complications created by statin drugs.

We came to the conclusion that one of the problems with the medical profession is that the different sets of specialists don’t talk to one another. Cardiologists don’t talk to gynecologists, and vice versa. People are afraid to step on somebody else’s toes and turf.

It’s sad, because their fear of rocking the boat has a direct and often negative effect on patients.

Try Bioidentical Hormones

Dr. Sinatra held his ground years ago and wouldn’t let me take Provera when my gynecologist wanted me to. Provera is absolutely toxic to the heart, he said.

Bioidentical hormones, however, are safe, and there are studies that indicate they reduce coronary artery spasm, breast cell proliferation, and risk of breast cancer. There are no problems with clotting or blood pressure. In many respects, they are the opposite of synthetic hormones because they confer specific health benefits and decrease risk for both cardiovascular problems and breast cancer.

You can get bioidentical hormones by prescription from your doctor. More and more conventional gynecologists are using them, including my own. If your gynecologist isn’t familiar with bioidentical hormones, I suggest you find a doctor who is—because they represent a safe and solid option for any woman with major menopausal issues.

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