The long term effects of estrogen deficiency that accompanies menopause vary among different women, owing to genetic, psychological and environmental factors. This means that some women will suffer from the effects of estrogen deprivation, while others will not and this individuality will seem very obvious to a physician specializing in this area. Generally, the loss of estrogen results in a higher risk of osteoporosis, cardiovascular disease and sexual dysfunction in post menopausal women.
Five years after menopause, the majority of women will have some thinning, dryness and shrinkage of the vagina, unless they take estrogen replacement therapy. There are women in their sixties and seventies who continue to have active and fulfilling sex lives in response to hormone replacement. For the increasing number of women in their seventies and eighties who want to be sexually active, vaginal atrophy (shrinkage) is a real concern. However, for many women, the problem is not deciding whether to be sexually active, but finding a partner, as on average, men don't live as long as women do.
Forty percent of American women will suffer from heart disease or a stroke as they go through menopause. Up to the time of menopause, women enjoy a certain amount of protection against cardiovascular disease compared with their male counterparts. Indeed, the incidence of heart attacks in women is only one third as great as the incidence in men. Unfortunately, after menopause, women begin to lose this relative protection from heart attacks and strokes, so that by the age of seventy-five, a woman's risk of developing these diseases is similar to that of a man.
So why do women become prone to cardiovascular disease after menopause? The most important factor appears to be the loss of estrogen in the body, which results in unfavorable changes in the blood cholesterol levels. Not only do overall cholesterol levels increase, but the level of low density lipoprotein cholesterols, the so-called "bad cholesterol" goes up, while that if high density lipoprotein cholesterols ("good cholesterol") go down. After menopause, this imbalance in cholesterol results in an increase in atherosclerosis (a condition characterized by blockage and hardening of the arteries), especially in women who smoke, who are obese and have sedentary lifestyles.
Early menopause is bad news for your cardiovascular system. Women who lose the function of their ovaries before the age of forty have a greater risk of heart disease than women who go through menopause when they are ten years older. The good news is that large-scale population studies have proven that estrogen replacement can restore a favorable balance in blood cholesterol levels. The risk of cardiovascular disease can be reduced by approximately fifty percent by taking estrogen at or soon after menopause. A study on hormone replacement therapy found breakthrough results for heart disease. The study showed that there were half as many cardiovascular deaths and heart attacks among women who took estrogen after menopause as there were among women who never used estrogen. This is because estrogen reduces total cholesterol levels, increases the proportion of the so-called "good cholesterol" and prevents cholesterol from being deposited in the walls of the arteries, thus preventing atherosclerosis.
The reduction of the incidence of stroke by hormone replacement therapy appears to be more modest, but it is still significant. A recent study of 23,088 Swedish women showed that post menopausal estrogen replacement therapy can reduce the overall risk of stroke by thirty percent.
We know now for sure that estrogen alone is good for your blood vessels and heart, but we are not sure if taking synthetic progesterone in addition to estrogen (as is now commonly done) reduces the benefits of estrogen on your cardiovascular system, particularly if you take estrogen and progesterone for many years. The ideal progesterone is yet to be found.
Your risk of cardiovascular disease is not determined only by the loss of estrogen. Other risk factors are equally important - and sometimes more important - as determinants of cardiovascular disease. These include smoking, high cholesterol levels, a family history of cardiovascular disease, high blood pressure, obesity, lack of exercise, a high fat diet and a diet that is deficient in raw foods, fish and liquids such as water and fresh juices.
Michael Russell
Your Independent guide to Menopause | |
