Estrogen, Breast Cancer, and Your Heart

By Jan Sinatra

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.

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