Just over 3 weeks ago, I looked over a study that concluded that vasomotor symptoms, hot flashes & night sweats, were associated with lower risk of breast cancer. Now, a new study just released this week in the journal Menopause, concludes, contrary to conventional wisdom, that early vasomotor symptoms were actually associated with lower risk of stroke, all cardiovascular events, and most importantly, all-cause mortality.
With all studies, but especially those that are contrary and controversial, I always suggest looking at how the study was performed and how significant were the statistics. In this particular situation, the authors followed 60,027 women in the observational arm of the Women's Health Initiative (WHI). Granted, there's been a lot of negative press about WHI, especially from the alternative & complementary medicine folks, but remember that this specific analysis was observational in nature. So one can't argue over horse-derived estrogen vs natural estrogen.
With all studies, but especially those that are contrary and controversial, I always suggest looking at how the study was performed and how significant were the statistics. In this particular situation, the authors followed 60,027 women in the observational arm of the Women's Health Initiative (WHI). Granted, there's been a lot of negative press about WHI, especially from the alternative & complementary medicine folks, but remember that this specific analysis was observational in nature. So one can't argue over horse-derived estrogen vs natural estrogen.
What's this mean for you & me? Well, probably just confusion for you but lots of confusion plus controversy for me since this study just opened up Pandora's box (again). Conventional wisdom over the last 2-3 decades has been that estrogen is protective of the heart (which is why women tend to have their heart disease manifest after menopause, typically 10 years later than men) which is why we previously thought that estrogen replacement would be protective. Now comes a new spin that less estrogen (leading to hot flashes & night sweats) is actually good for you!
The authors rightly concluded that they need to perform more studies (how else will they put food on the table?) but more importantly, whether the individual's timing of menopausal onset represents distinct processes and different risk profiles. Only time will tell. But as I mentioned 3 weeks ago, perhaps our patients can re-interpret their early symptom onset given the positive outlook further down the road. As for treatment with estrogen with(out) progesterone, that requires more space than I have to type (and more time for an informed discussion with your healthcare provider to understand your individual risks).
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