Please do discuss estrogen with your own doctor before making any decisions about therapy.
As a board-certified gynecologist with decades of experience, I sometimes want to scream in frustration over the medical misinformation that pops up on social media. At the top of that list is misinformation about the use of menopausal estrogen therapy. Here, I will clear up those myths and misconceptions, giving you the facts about what estrogen will do for you according to current scientific evidence. I am not including issues that are still controversial, like whether estrogen therapy can decrease the risk of dementia. This list is not based on my opinion or my own clinical experience. What follows has been proven in well-designed studies and echoes the 2022 North American Menopause Society Position Statement on Hormone Therapy.
Peri- and postmenopausal women who take estrogen have:
- Fewer hot flashes. Up to 80 percent of women have hot flashes that not only disturb sleep but are associated with heart disease, insomnia and perimenopausal memory problems. Those hot flashes last on average seven to ten years. Estrogen therapy will alleviate hot flashes 75 percent of the time.
- Better bone health. In the United States there are 10 million women with osteoporosis and 43 million women with osteopenia. Osteoporosis is responsible for approximately 2 million fractures annually. Estrogen prevents bone loss and decreases fracture even in women without osteoporosis.
- Less cardiovascular disease. Cardiovascular disease is the number one cause of death in women. The use of estrogen between the ages of 50 and 60 or within 10 years of entry into menopause results in a significant decrease in cardiac markers associated with heart attack, stroke and coronary heart disease.
- Better sex lives. Up to 80 percent of women have vaginal and vulvar changes as a result of low estrogen. Both systemic and local vaginal estrogen will turn sandpaper sex into satisfying slippery sex by increasing lubrication, blood flow and sensation in vulvar and vaginal tissues.
- Less insomnia. You don’t need me to tell you about peri- and postmenopausal sleep problems! In addition to making you feel exhausted, sleep disturbance is associated with mood fluctuations, obesity, memory problems and cardiovascular disease. Estrogen helps eliminate hot flashes that sabotage sleep and has been shown to be beneficial in women who do not have hot flashes.
- Improvement in urinary symptoms. Overactive bladder and recurrent urinary tract infections are a direct result of estrogen-starved tissue. The use of a local vaginal estrogen has consistently been shown to reduce or eliminate those symptoms.
- Better mood. There is solid evidence that estrogen enhances mood and improves well-being in nondepressed perimenopausal women.
- A reduction in type 2 diabetes. This is a big one, and not well appreciated. Not only does hormone therapy help delay the onset of type 2 diabetes, but in women who have the disease, estrogen appears to increase insulin levels and improve glucose control.
- Lower risk of colon cancer. Colorectal cancer is the third most common cancer and the third leading cause of cancer death for women in the United States. There is a well-documented reduced incidence and mortality from colorectal cancer in hormone therapy users.
- Decreased joint pain. My patients who stop their hormone therapy are not surprised that their hot flashes return, but most had no idea that their arthritis would also return. Women documented in scientific studies had less joint pain or stiffness with hormone therapy than with a placebo.
- Better skin. Anyone who has listened to my podcast on estrogen and skin knows that estrogen therapy increases skin thickness, increases collagen, increases elastin and decreases wrinkles.
- Better quality of life. There are legitimate ways to measure quality of life, and in estrogen users, it is much higher than in non-estrogen users. It is hardly shocking that if you can sleep, think, have sex and stop peeing every 10 ten minutes, you will enjoy life more. Which is a good thing, because if you take estrogen, you will.
- Less chance of dying. Women who take estrogen between ages 50 and 60 or within 10 years of the menopause transition have a 30 percent decrease in all-cause mortality. If that doesn’t get your attention, I give up.
What estrogen won’t do is give you breast cancer
In July of 2002, when the results of the Women’s Health Initiative were released, millions of women turned on the news to hear that the estrogen they took every morning could cause breast cancer.
The news immediately went viral, and there was a collective national flush as understandably nervous and angry women tossed their hormones down the toilet. Sales immediately dropped by 70 percent. Even though that study is now 20 years old, and even though it has been revaluated and shown that the study was misinterpreted, doctors continue to tell patients that taking estrogen will increase the risk of breast cancer, and the FDA still lists it as a warning on the product label.
But further analysis of the data showed that it was only the group that took estrogen and a synthetic progesterone (medroxyprogesterone acetate) that had a slight increase in breast cancer. The women in the 50-to-60-year-old group who took estrogen alone had an 18 percent decrease in breast cancer. You read that right. The news flash that didn’t make it to the media was that women in the estrogen-only group had a lower risk of breast cancer than women who did not take estrogen.
It's now clear that the small increase that is sometimes seen in breast cancer in women who take hormone therapy is due to the progestin, not the estrogen. And, we now know, it wasn’t just the progestin that was the culprit; it was the specific progestin that was administered in the study: medroxyprogesterone acetate, a synthetic progesterone. A new study that was released in 2022 included women who were taking micronized progesterone with their estrogen, and there was no increase in breast cancer.
In my podcast episode titled “The TRUTH About Hormone Therapy: Does it CAUSE or Does it PREVENT Breast Cancer?” I go deeper into detail explaining this data and talking about the risks of hormone therapy, including a small increased risk of blood clots with oral estrogen. It’s important to note that the increased risk of blood clots is not seen in transdermal or vaginal products.
Have any of you tried estrogen therapy? Let us know in the comments below.
