FELICE L GERSH Internal Medicine, Fellowship in Integrative Medicine, University of Arizona College of Medicine, Irvine, California, USA
JAMES H O’KEEFE University of Missouri-Kansas City, Department of Cardiology, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
CARL J LAVIE Cardiology, John Ochsner Heart and Vascular Institute, New Orleans, Louisiana, USA
The loss of ovarian hormone production during menopause parallels the progression of the cardiometabolic diseases of aging – including diabetes, hypertension, strokes, and myocardial infarction. Nevertheless, despite an abundance of scientific data, menopause remains poorly understood for its wide impact on female health. Only by acknowledging the significant role played by ovarian senescence and its associated loss of ovarian hormone production, will the medical approach to menopausal women be optimized.
The connection between the dramatic decline in ovarian estrogen and progesterone production and the ramifications this has on the health of postmenopausal women is reviewed in this article. The data supports a renewed interest in the prescriptive use of human identical hormones to reduce the development of the related cardiometabolic diseases.
Figure 1: Age-dependent shift in oestrogen levels. Levels of oestrogen decline with age and result in increased visceral fat, higher rates of insulin resistance and an increase in cardiovascular disease.
For many years, replacing the hormones lost subsequent to menopause was highly encouraged, but that practice came to an abrupt halt with the unexpected, premature closure of the landmark study, the Women’s Health Initiative (WHI). Unfortunately, the mode of estrogen delivery, and the specific forms of the hormones utilized in the study, were ultimately found to be harmful, and on reanalysis, many of the conclusions were modified. Nevertheless, huge numbers of women worldwide discontinued hormone use and their prescriptive use plummeted. Only recently has the use of hormones in menopausal women begun to slightly increase.
This article reviews the positive findings of the early, observational studies, the unfortunate misunderstandings and misapplication of the data associated with the WHI, the subsequent more reassuring studies, and the basic science supporting the use of human identical hormones in appropriate, recently menopausal women. The authors promote a greater understanding of female hormones and their positive health benefits in women. The goal is for a paradigm shift in the current thinking of the roles played by human identical estrogen and progesterone, thereby re-establishing their widespread use.
Conclusions from the article:
- Data support endogenous E2 and P4 as cardioprotective—numerous animal and observational studies reveal CV beneficial effects.
- Discordance of WHI/HERS and data on hormone benefits is likely explained by the (1) Timing Hypothesis, (2) negative CV effects of CEE+MPA, (3) pre-existing CVD and older age of women in WHI and HERS.
- Transdermal E2 with oral P4, begun early in menopause, appears to support long-term CV health.
- Recommendations for the ‘lowest dose’ of HT derived from the negative data on CEE and MPA. HERS and WHI data should not be applied to human-identical transdermal E2 and oral P4.
- E2 effects are dose related. Low E2 doses, resulting in serum levels near typical PM levels, are less likely to provide benefits compared with physiological dosing.
- Women have high rates of CVD after menopause. Human-identical hormones initiated early in menopause appear safe to be continued indefinitely, under close supervision, offering PM women greater potential for long-term CV health and improved quality of life.
- Individualised decision-making is a key component of all HT conversations; standard CVD risk reduction must be included in all therapeutic plans.
Read full article here (extract from the ACNEM Journal September 2021 edition)
Dr Felice Gersh
Felice Gersh, M.D. is a multi-award winning physician with dual board certifications in OB-GYN and Integrative Medicine. She is the founder and director of the Integrative Medical Group of Irvine, which provides comprehensive health care for women by combining the best evidence-based therapies from conventional, naturopathic, and holistic medicine.
An active part of the PCOS community, Dr. Gersh works with the PCOS Awareness Association and is a member of the PCOS Challenge’s Medical/Scientific Advisory Board. She speaks at the annual conferences of both non-profit organizations. She is a member of the AE-PCOS Society, and has spoken multiple times at their prestigious academic meetings.
She taught obstetrics and gynecology at Keck USC School of Medicine for 12 years as an Assistant Clinical Professor, where she received the highly coveted Outstanding Volunteer Clinical Faculty Award. She now serves as an Affiliate Faculty Member at the Fellowship in Integrative Medicine, through the University of Arizona School of Medicine, where she lectures and regularly grades the case presentations written by the Fellowship students for their final exams. She has had many scientific articles published in prestigious medical journals, and most recently had an article chosen to be featured in Mayo Clinic Proceedings.
Additionally, she is a sought after medical forensic expert and has worked on numerous high profile legal cases.
Felice Gersh, M.D. is the bestselling author of PCOS SOS and the PCOS SOS Fertility Fast Track and her newest book, Menopause: 50 Things You Need to Know, is now available on Amazon. She is a prolific lecturer and has been featured in several films and documentary series, including The Real Skinny on Fat with Montel Williams and Fasting with Valter Longo, Ph.D.
Learn from Dr Felice Gersh at our upcoming Menopause Masterclass on 12-13 March 2022. Don’t miss this chance to learn directly from one of the most globally recognised experts on women’s health!