Prevention is Key to Healthy Aging

"Our healthcare system cares more about treating disease than preventing disease or death. We literally have cheap safe medications in hormones that decrease your risk of death, but we don't give them to women." This rings so true with my experience with Western Medicine. As I entered menopause, my low bp suddenly became high bp that wouldn't settle down to the point my primary care doctor prescribed bp medication and statins (with horrible side effects). I asked the doctor what was causing the sudden shift in my bp and couldn't we deal with and heal the cause? "Oh, it's probably because of low estrogen from menopuase. Your blood vessels are no longer smooth inside and it is harder for blood cells to push through." was her response. So can we treat that? NO! hormones are not allowed. It's just crazy.

So lets talk about the protective effects of hormones on the heart. Whether you are feeling heart palpitations or raised blood pressure, these can all be symptoms of perimenopause and menopause. Heart palpitations are thought to occur in menopause because lower estrogen levels impact the electrical pathways of the heart. Up to 42% of perimenopausal women and 54% of post menopausal women report having heart palpitations and they are often sent to a cardiologist, as I was. Here is a quick list of how estrogen benefits the cardiovascular system:

Supports the lining of blood vessels, mitochondrial healtha dn Nitric oxide

production in arteries

is Anti-inflammatory

decreases insulin resistance and supports a healthy lipid profile

helps cardiac muscle cells and stem cell survival

modulates mitochondrial ATP synthesis in the heart (energy production)

reduces pathologic cardiac hypertrophy (heart enlargement)

protects the perimenopause heart during the transition from hypertension and

ventricular diastolic dysfunction.

So estrogen is protecting the heart and vascular system. In a 2024 study (Napoli, N. (2024) Heart health declines rapidly after menopause. American College of Cardiology) The authors findings suggest that plague buildup in the arteries accelerates when women's hormones decline even when on statins. The women studied who were on statins and menopausal were not being protected from plague accumulation but they were reaping the dangerous side effects of the statins. So why are we more afraid of hormones than statins? In 2012, 37 million women were placed on a statin. In 2018 that increased by147% to 92 million women being placed on a statin and for most of these women there is no history of heart disease and no reduction in plague formation. Contrast that with a study conducted in 2024 (Baik, SH, Baye, F and McDonald, CJ. (2024). Use of menopausal hormone therapy beyond age 65 years and its effects on women's health outcomes by types, routes and doses. Menpause, Apr 9) which found natural hormone therapy reduces all cause mortality, mainly from heart disease, by 30% in women aged 50-60. For women over 65 who continue therapy, overall mortality decreases by 19%. Less than 1 in 20 women take hormones.

The best prevention of heart disease is starting hormone therapy early.

Other benefits seen from hormone therapy in menopause include Body Composition. We loose lean body mass in bone and muscle and gain adipose tissue or fat, which is an inflammatory tissue. This redistribution of lean/fat tissue is happening at the cellular level. Estrogen deficiency impacts carbohydrate adn lipid metabolism. While weight loss is not a reason to supplement with hormones, it is a measure of what is happening to our bones and muscles that needs to be addressed.

changing body composition in women

Another big issue in menopausal women is an increased risk of type II Diabetes and insulin resistance (from increase in adipose tissue size/ratio). Four major studies have shown that taking estrogen and progesterone reduce the incidence of diabetes by 35%. That is huge yet it isn't talked about in the doctors office.

Several studies have shown a protective effect of hormone therapy on decreased risk of age related macular degeneration, some show by as much as 50%. Estrogen receptors are in the retina and help iwth reducing inflammation and it helps maintain proper eye pressure and lubricates the eyes.

Insomnia affects about 50% of perimenopausal and menopausal women. While it is important to maintain a healthy night time routine to prepare your body and mind for sleep, progesterone has been found to play a key role in helping you fall asleep, while estrogen helps you stay sleeping and testosterone (which is produced during sleep) has been reported to improve sleep quality

sleep struggles in menopause

During menopause, the brain is starving for estrogen. "Hormones are brain chemicals. Brains change when hormones change. Hello, remember puberty? And when we talk about the brain changes in midlife many things come into discussion. Brain fog, depression and anxiety and dementia." The brain is highly sensitive to hormone changes. More than half the women experience brain fog in perimenopause. For some this brain fog can improve after menopause asa the huge swings in estrogen settle down. Starting on hormone therapy as have that last period helps greatly reduce brain fog. For me it has gotten worse as I move through menopause to post menopause. Sometimes it scares me (I think Alzheimers would be the worst diagnoses). For me this involves more complicated measures, such as supplementing with estrogen and progesterone, trying nootropic herbs, working on reducing inflammation by taking anti-oxidants such as fruit anthocyanins (concentrated liquid), liposomal NAD+, liposomal glutathione, black seed oil, and herbal anti-inflammatories. I don't take them all at the same time. I work with my medical team to determine dosage and when to use them. For me the improvements are happening, but it is a slower process not an overnight change.

brain health

Depression and Anxiety also increase during perimenopause and menopause. the CDC published a study from 2015-1018 that the use of anti-depressants by women increased at double the rate of men, especially for women over the age of 60. It is still not understood why depression increases. For me it has been caused by this feeling that my body is falling apart and there is nothing I can do about it. I see the things I love to do being harder and harder to do and I see a bleak future as I age. It breaks me down into tears some days as my memory isn't working as well, my body is aching and my heart is racing. Studies clearly show the positive effect of progesterone on anxiety and increased calm. Estrogen with progesterone seems to have an added impact.

ADHD us another rising diagnosis in menopausal women. "There is now data linking a decrease in hormones to an increase in symptoms such as inattention, forgetfulness, and feeling overwhelmed. This is because hormones in the brain work to modulate dopamine and serotonin. While there are no studies showing improvement in ADHD symptoms with hormone therapy, we do know that pregnant women (in a high hormone state) tend to have less ADHD symptoms

The symptom I most fear is dementia. Two thirds of Alzheimer's cases are in women. Did you know that. For the brain and Alzheimer's, if you want to consider hormones for protection or prevention, you need to start them younger. Estrogen's superpower is in prevention not in treating disease. A 2021 study showed that of the 380,000 women studied, those on hormone therapy had a 60% decreased risk of ALL neurodenerative diseases (dementia, MS, parkinsons, etc). (Kim, YJ, Soto, M, Branigan, GL, Rodgers, K and Brinton, RD. (2021). Association between menopausal hormone therapy and risk of neurodegenerative diseases: Implications for precision hormone therapy. Alzheimers Dement. May 13). Hormones play a powerful role as a protector of the brain.

Some recent studies are showing testosterone therapy in women between 49-60 years old showed significant improvements in memory and in verbal and visual learning compared to placebo group. It was a small study, but so few companies are willing to do research on hormone therapy.

Okay, last category to study is the musculoskeletal system. One of the most devastating consequences of menopause is the musculoskeltal syndrome of menopause. More than 70% of menopausal women will experience this and 25% will be disabled by the symptoms through the transition from perimenopause to postmenopause. "Estrogen has a profound effect on the musculoskeletal sustem and unless you take action, when estrogen is no longer being produced, you can lose bone density up to 20% in the years immediately following menopause, lose muscle and have a rise in inflammaton." (Vonda Wright. Unbreakable). Dr. Wright goes on to explain that lower levels of estrogen meant that our osteoclasts, the cells that break down bone, work without regulation and outpace our osteoblasts, the cells that build and repair bone. Estrogen receptors are also present in our muscles and influence our muscle mass and strength. The decrease in estrogen during menopause leads to decreased muscles protein synthesis and increased degradation. The third role of estrogen on our musculoskeletal system is as an anti-inflammatory which helps maintain the health of our joint tissues and cartilage. So to put it together, in menopause we are loosing muscle and feeling weaker, loosing bone and more fragile and afraid to move and it puts us in pain.

musculoskeletal syndrome of menopause

Menopause is not a time to sit it out. It is crucial that we work with a personal trainer to develop a work out program specific to your body and to strengthen bone, build muscle and maintain flexibility. For me that has been a combination of yoga routine, weights (I'm still developing that one), fast walking and jumping (step up and off a tall box or walking up and down stairs). It is also crucial we are eating healthier than ever and getting plenty of Calcium and magnesium in our diets (think carrots, celery, cheese, etc). If you don't take care of your body it will take care of your freedom by taking away your ability to move as you want to. Osteoporosis and Osteoarthritis are no joke. It is painful and limiting. Supplementation with estrogen shows significant improvement in both muscle and bone mass, however, that decreases quickly as soon as you stop supplementing. It is recommended you stay on hormone therapy for life to support bones and muscles. The most pronounced benefit occurs if hormone therapy is started in perimenopause. The longer you wait to start supplementation, the benefit decreases. Remember, estrogen is a disease preventor and protector not a treatment. Once bone has deteriorated, you cannot get it back.

Well, I think that was long enough of a post. Next week we will start discussing resources and treatment/supplementation options other than just hormones. Stay with us and as always, please share your experiences and questions.

#menopause #hormone therapy #prevention #estrogen #menopausal symptoms