What women should know about the estrogen-atherosclerosis connection

Hormone replacement therapy (HRT) has gained somewhat of a mixed reputation in recent years. It’s true that HRT is not a good idea for certain women, such as those who have had breast cancer or are at high risk of breast cancer.

But experts do agree that most healthy, recently menopausal women can safely choose to use HRT to relieve symptoms such as hot flashes, mood swings, dry skin, sleeplessness, irritable bladder and vaginal dryness.

However, HRT is not without its risks. Like birth control pills, both estrogen and estrogen with progestogen regimens raise the risk of blood clots in the legs and lungs, although the risk is rare in women between the ages of 50 and 59.

There is also an increased risk of developing breast cancer with 5 or more years of continuous estrogen/progestogen therapy. The risk drops as soon as HRT is stopped. In studies, the use of estrogen alone for an average of 7 years was not shown to increase breast cancer risk.

The bottom line appears to be that the use of estrogen in HRT is relatively safe for most women. And that’s good news because there’s another reason besides menopause relief that women should consider estrogen HRT…

Estrogen therapy and your blood vessels

A new study has confirmed that HRT with estradiol, a form of estrogen, can slow the progression of atherosclerosis. The study was based on data from the Early Versus Late Intervention Trial With Estradiol (ELITE), which compared estradiol with placebo in postmenopausal women.

Most cases of cardiovascular disease center on atherosclerosis, a chronic inflammatory process of the blood vessels characterized by a buildup of fats, cholesterol and other substances. Women’s risk of cardiovascular disease greatly increases after menopause, and cardiovascular disease remains the leading cause of death in U.S. women.

Data from ELITE had already shown the benefits of HRT in reducing the progression of atherosclerosis in relatively younger, healthy postmenopausal women. In this new study, researchers specifically looked at the effect of HRT on 12 inflammation biomarkers in 643 postmenopausal women involved in ELITE.

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The analysis confirmed that HRT significantly reduced the circulating concentrations of several key biomarkers. Women who were less than 6 years into menopause showed the greatest anti-inflammatory benefits from estradiol compared with women more than 10 years after menopause.

“This study helps us better understand the potential physiologic mechanisms that could explain why hormone therapy slows the progression of heart disease early after menopause, but not in women more distant from the menopause transition,” says Dr. Stephanie Faubion, medical director of the North American Menopause Society (NAMS). “Additional research is needed to more fully understand how time since menopause alters the impact of hormone therapy on heart disease risk.”

Other benefits of HRT

This is not the first study to note HRT’s heart health benefits. A study published in 2017 observed that HRT lowered coronary artery calcium (CAC) scores in a large cohort of postmenopausal women and that it was associated with lower mortality from all causes. High levels of CAC can indicate there’s a buildup of plaque in the arteries.

In addition, research has demonstrated that estrogen HRT increases HDL cholesterol, the “good” kind of cholesterol, and decreases LDL cholesterol, the “bad” kind that can lead to atherosclerosis. Estrogen HRT also has been connected with increased elasticity of the blood vessels, which allows for better blood flow throughout the body.

Some other benefits of HRT include a lower risk of osteoporosis and fractures and decreased incidence of colon cancer. Estrogen has long been used for the prevention of postmenopausal osteoporosis because of its ability to preserve bone mineral density (BMD) at all skeletal sites. And a study found that oral HRT use was connected with a 63 percent reduction in the risk of colorectal cancer in postmenopausal women after adjustment for other known risk factors.

If you’re a woman in menopause and have no risk factors, you can obtain a prescription for estrogen HRT from your doctor. Or you can raise your estrogen levels through more natural means…

Natural sources of estrogen

Studies indicate that eating plant-based foods rich in phytoestrogens may help women raise their estrogen levels. Try adding the following foods to your diet:

• Seeds such as flaxseeds and sesame seeds
• Fresh and dried fruits like apricots, oranges, strawberries and peaches
• Vegetables such as yams, carrots, alfalfa sprouts, kale and celery; soybeans and soy products
• Legumes like lentils, peas and pinto beans
• Chickpeas
• Olives and olive oil
• Dark rye bread
• Herbs like turmeric, sage and thyme

Try to maintain optimum levels of vitamins B and D, both of which play a role in estrogen creation and activation. And consider taking herbal supplements like black cohosh, which may stimulate estrogen receptors; red clover, which contains isoflavones that may act like estrogen in the body; and the traditional Chinese medicine dong quai, which contains two compounds that exhibit estrogenic activity.

Sources:

How Hormone Therapy Slows Progression of Atherosclerosis — North American Menopause Society

The Experts Do Agree About Hormone Therapy — North American Menopause Society

Hormone replacement therapy is associated with less coronary atherosclerosis and lower mortality — Journal of the American College of Cardiology

Coronary Calcium Score and Cardiovascular Risk — American College of Cardiology

Estrogen & Hormones — Cleveland Clinic

Hormone replacement therapy and the prevention of postmenopausal osteoporosis — Przeglad Menopauzalny

Foods that May Help Boost Your Estrogen and Testosterone Levels — MDVIP

12 Natural Ways to Boost Estrogen in Your Body — Healthline