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Estrogen– Is It the Devil or Your Heart's Best Friend?

By Expert HERWriter
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Estrogen saved my life.

I’m not talking about the estrogen my body used to produce. That disappeared the day I had my hysterectomy. If you haven’t heard that part of my story, check it out here.

I’m talking about my hormone replacement therapy or HRT. It took months, but when I finally found the right combination of estradiol and testosterone it literally saved my life. I could not have kept living the way I felt without my hormones.

So when I hear about doctors who warn patients away from HRT without giving them all the information, it makes me mad. And when I learn first-hand that doctors are giving out wrong information based on studies that have been shown to be inaccurate, it makes me furious!

Here’s what happened to me.

I consider my primary care doctor as the quarterback of my health team. She’s the key to keeping my entire body healthy. But because of my hysterectomy and all the problems hormone imbalance caused me, I also have a hormone specialist who takes care of that part of my life.

But no matter how great they are, my doctors can only work with the information that I give them. Here’s where things almost got messed up in a big way.

A few months back, I realized I was having symptoms that had me worried. Periodically it felt like my heart was being squeezed and released. It took my breath away when it happened. Thinking back on it, I also realize that I’d been having occasional chest pain and shortness of breath. But it didn’t happen often enough for me to really put it all together.

When I finally thought to talk to my doctor about my symptoms, she started with a typically opening line – was I under stress? Picture me shaking my head in disgust. Of course I was under stress! I’ve been traveling so much I was losing weight and when I was home, I was always playing catch-up between my family and work.

And really, what woman doesn’t have stress! Don’t get me started on the whole subject of work/life balance for women. There is no such thing in my book. We have too much on our plates to ever think it’s going to balance out.

Read more in Advancing Health After Hysterectomy

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Facing Hysterectomy Together: How is a Hysterectomy Likely to Affect Our Sex Life?

Our Hysterectomy: About the Vagina

Our Hysterectomy: About the Vagina

Estrogen Therapy Reduces Breast Cancer Risk After Hysterectomy: True or False?

Estrogen Therapy Reduces Breast Cancer Risk After Hysterectomy: True or False?

Our Menopause: When Facing a Hysterectomy Should You Retain or Remove Ovaries?

Our Menopause: When Facing a Hysterectomy Should You Retain or Remove Ovaries?

All in Advancing Health After Hysterectomy

Add a Comment10 Comments

EmpowHER Guest

Hi Michelle,
Congratulations on your wonderful work and advocacy! I am 58 years old, and experiencing some weight gain, constant hot flashes, that exact heart squeeze and flutter you described, bouts of depression and sleeplessness and feeling just out of whack. I am very healthy, except for having had a serious medical crisis about 8 years ago: After flying to various destinations in a shot period of time (and not getting up from my seat while I was on planes), I returned home experiencing severe lung pain. Turns out I had a pulmonary embolism--a blood clod that landed in my lungs. Extensive testing showed that this was not caused by heredity, nor did I have any blood disorders. it was --as the doctors said -- a fluke. My gynecologist will not prescribe any form of hormone, because hormone therapy increases the risk of blood clots. Any suggestions? Thanks,

October 7, 2014 - 9:22am
Expert HERWriter
Sharon, I was sitting here reading your post and started to sob! I am SO happy you found the right doctor and got on the right HRT program. It's amazing how much better you feel when you have the right treatment plan for you, right? I just wish every woman knew about EmpowHER.. there would be a lot less silent suffering going on. If women only knew what a role hormones play in their bodies. Thank you from the bottom of my heart for not only giving me credit, but giving EmpowHER credit for improving/saving your life. But the truth is it was you who advocated for yourself... which is the best!! YOU took control. You've given me renewed faith in what I do every day! It also makes our team feel so good when they read a post like yours. We all work so hard to try to help women be well and stay well. Just know we are always here for you! Big hug! MKRSeptember 5, 2014 - 2:02pm

Thanks, Michelle. Great article and great comments. I , too, had a hysterectomy, now about 2 1/2 years ago. My Gyn surgeon prescribed Estradiol and Progesterone. I'd been on progesterone only birth control pills decades before and my body did not respond well; spotting and extreme sudden weight gain, so I was concerned about this. I started experiencing the weight gain again, so I stopped the progesterone, but I was also experiencing incredible fatigue and lower back and leg weakness. If I was standing for even 5 minutes my legs would practically give out. I went through an MRI and the doctors found no explanation. I found EmpowHER then, and I went in search of a hormone specialist, which I found in the doctors at my local Medspa, who ordered a complete hormone panel, and we found that my Testosterone levels, for a woman, were extremely low. I started on a subcutaneous treatment of my Estrodial which was a lower dosage and thought to be lower risk than the oral I'd been proscribed, alone with testosterone, and almost immediately the back pain and weakness disappeared. I am now in the best shape of my life, at 47, and I'm even running marathons (which I thought I'd never even want to do). Michelle, EmpowHER, and Dr. Bentz have saved, and significantly improved my quality of life! Thank you so much, and keep up the fight!

September 5, 2014 - 10:14am
Expert HERWriter

I have to respectfully disagree. It happened to me. I lived it and still am living it. Every day I was a science project because no one knew how to treat me after my hysterectomy. I was overdosed on progesterone and given 100 x's the required dosage for someone who has a uterus! I didn't have one. Why in the world would I need progesterone without a uterus?

You need to look at the studies I talked about in the article. Show me the studies that say progesterone will benefit a woman after she's had a complete hysterectomy. It made me deathly ill taking progesterone and caused me to have severe depression, weight gain (just what I didn't need), bloating and edema, just to mention a few of my symptoms. I was told to rub it all over my body. I never felt so sick!!!

Also, after my hysterectomy my cholesterol numbers went up. My cholesterol was always normal until then. It continued to go up until I got on the right HRT regime. Which for me was estradiol and a bit of testosterone. All of a sudden my bad cholesterol decreased by over 50 pts and my ratios were so much better. So, you can't tell me there is no benefit to the heart when it comes to Estrogen! I have lived this nightmare and have been over medicated, under medicated, given medications I should have never have had and now have to take them for the rest of my life because someone thought maybe I had a thyroid problem. I have to have at least one more surgery as well.

Here's the truth- I was having heart issues and then my Hormone Doctor who specializes in women and hormones gave me a bit more estrogen and the heart issues were gone. Totally gone. Have not had another episode since. How does one explain that?? I want you to be informed and it sounds to me like you are very informed in many areas but are missing a big piece of this whole hormonal puzzle. I'm happy to give you more studies about estrogen and the benefits. I also have some on why I shouldn't take progesterone if you'd like too. I want you to be informed as I wouldn't want you to go through the same thing I did if you're a woman, and/or have someone you know have it happen to them. I feel the BEST I've ever felt at 54 years old and no progesterone is needed.

I almost died because some health care professionals are misinformed. It's not their fault, it's the fault of the broken system in which we continue to live with in today's world. But please don't tell women that estrogen can protect their hearts. You sound like the cardiologist who wanted to take me off of it. She could have killed me! I've been through enough and seen enough and read enough to know about hormones. No, I'm not a doctor but I certainly am an educated patient by default because of misinformation around women and hormones. Why can't we all have consensus around this topic? Just goes to show you how little we've done to get good solid information out to the consumers as well as the healthcare professionals.

Please show me the studies about estrogen coupled with progestins and how it reduces all of these female cancers etc... I would love to see what you're talking about as I've not seen these studies before. I am more than willing to read and learn anything and everything I can so women can get the best information around their hormonal health and overall well being. That's the most important thing for me as the founder of this company.

Thank you for commenting on my article. It starts a great debate which I believe is healthy for everyone concerned. We need to have great data and studies for women around their hormonal health. Today, we are boxed into the WHI which didn't help women and or doctors. We now know it killed at least 50,000 women because women went off of their estrogen. That study is on our site. I want science based information and studies proving points. That's why I always ask a thought leader in a particular area of women's health before I post an article like this. Hence, the reason Dr. Phillip Sarrel is referenced in the article and knows the studies. He is a thought leader in this field. Let's see if we can get him to comment on this as well. The more information and studies we can find....the better it is for all women and their doctors. Be well! MKR

September 4, 2014 - 4:02pm
EmpowHER Guest
Anonymous (reply to Michelle King Robson)

I was very careful to say progesterone and not progestIN. Very different substances.

Like I said, unopposed estrogen has unique risks - afib, abdominal aortic aneurysm, decreased verbal fluency, and certainly uterine cancer (if you have one). The French E3N study also suggested that unopposed estradiol (without progesterone) increased breast and ovarian cancer, whereas estradiol and progesterone (not progestins) did not.

While no randomized trial has ever been conducted on estrogen with progesterone in women without a uterus, there also have never been any long term clinical trials of estradiol alone in women with hysterectomy. Unopposed estradiol increases recurrent stroke and stroke death and secondary cardiovascular prevention studies show early increases in MI and blood clots.

The points I am making AREN'T "don't take estrogen ever", they are 1. don't take estrogen WITHOUT natural progesterone 2. don't expect hormone "replacement" to protect you from age related disease. That has been disproved. True, WHI was imperfect for many reasons. But the age-based analyses were a statistical manipulation of the data to try to eke out some benefit from estrogen that obviously was not there. Statisticians will tell you that if you do enough analyses (32 or more), you will come up with a statistically significant "finding" that may or may not be true.

September 25, 2014 - 12:41pm
EmpowHER Guest
Anonymous (reply to Anonymous)

Below are links to clinical trials (some were part of the WHI). Also a few observational studies. My point is to highlight the risks of taking estrogen WITHOUT progesterone. (For progesterone to effectively counterbalance estrogen it must be given in an oral micronized form; creams are insufficiently absorbed to protect the uterus and breasts or improve sleep).

1. E-alone increases atrial fibrillation.

2. E-alone lengthens the QT interval (an arrhythmia that predisposes to both sudden cardiac death and torsade de pointes); progesterone and/or testosterone SHORTEN it

3. E-alone increases peripheral arterial disease, particularly abdominal aortic aneurysm.

4. E-alone decreases verbal fluency in "younger" postmenopausal women

5. Combined testosterone and estradiol have no positive impact on cognition, verbal or spatial abilities

6. Estradiol triples the risk of fatal stroke

7. Estradiol alone without progesterone increases both breast and ovarian cancer (French E3N study)

These studies indicate that progesterone is not just some annoying tagalong to estrogen to protect the uterus. It is both a partner to estrogen and a counterbalancing hormone. All the negative symptoms that get dinged as "PMS" or "menopause" (mood swings, negative affect, bloating, breast tenderness, heavy bleeding, migraines) are not due to progesterone; they are due to high estrogen. The best evidence for this is puberty: a time when adolescent girls are dealing with an overwhelming surge of estrogen, necessary to mature their bodies. But it takes years for ovulation (and sufficient progesterone) to become consistent and to "calm" this chaos. Perimenopause is the same phenomenon: high estrogen, low progesterone, and MUCH misery.

Anecdotes aside, the body of evidence supports the concept that unopposed estrogen, whether as HRT or even in a woman's own body, is neither safe nor beneficial to quality of life. If you absolutely must take estrogen after menopause, added progesterone is also necessary, uterus or no uterus.

September 26, 2014 - 3:40pm
EmpowHER Guest

Estradiol (or any other estrogen) does not prevent heart disease. That your physician did not include progesterone as part of your hormone "replacement" is physiologically unsound. Doctors think that progesterone's only job is to protect the uterus and that with no uterus, all you need is estrogen. That is wrong.

Unopposed estrogen increases the risk of certain diseases and conditions not seen with combination estrogen/progestin (I know that progestin is not progesterone but it is the most studied compound, so I will reference that here, KNOWING that it is a subpar substitute for natural progesterone): increased risk of atrial fibrillaton and a prolonged QT interval (both potentially fatal arrhythmic disturbances); abdominal aortic aneurysm; obviously uterine cancer; possibly ovarian cancer; decreased verbal fluency. Estrogen/progestin also lowers the risk of colorectal cancer and diabetes and improves quality of life (sleep, bodily pain, and emotional wellbeing). (E-alone does not.) Estrogen/progestin is also better for bone than estrogen alone and leads to a greater increase in bone density and sustained fracture prevention even after cessation of therapy. Again, estrogen alone does not.

When a woman complains of heart palpitations and fast heartbeat, that usually occurs during perimenopause, not postmenopause. Perimenopause is not a time of dropping estrogen - rather it is a phase of life characterized by HIGH and swinging estrogen levels and low or absent progesterone. That is why there is a mix of "menopausal" symptoms, like hot flahses and night sweats, but also premenstrual/pubertal symptoms, like sore breasts, heavy flow and mood disturbances.

As far as heart DISEASE is concerned, neither estrogen nor estrogen/progesterone prevents it. Estrogen increases clotting, and it is that pitfall that probably explains why the hormone increases the risk of stroke, blood clots and heart attack. (Remember a woman's own estrogen during pregnancy puts her into a hypercoagulable state, which explains the small increased risk of vascular complications seen in a small percentage of pregnant women.)

August 31, 2014 - 10:19pm
EmpowHER Guest
Anonymous (reply to Anonymous)

I want to respond to your first sentence as that addresses the subject of the original article by Ms. Robson. Her chest pain responded to estrogen therapy which is what I would have expected. As to estrogen reducing the risk of heart disease and preventing myocardial infarction: The most recent reports of the Women's Health Initiative(WHI) study of women who have had a hysterectomy and who start estrogen within 10 years of losing their ovarian hormones clearly indicate a reduction in coronary heart disease of 40% and reduced mortality of 11/10,000/year. (Manson et al. JAMA 2013;1353-1368). The WHI findings confirm numerous cohort studies since the 1980's (starting with the coronary drug project) showing that treatment with estrogen alone reduces the risk of heart attacks by over 40% and reduces mortality . Estrogen acts in many ways in the wall of arteries to prevent constriction, stabilize blood flow and inhibit the development of atherosclerosis, the underlying cause of most heart attacks. The WHI findings also indicate that the women who received estrogen-only treatment, whatever their age group, showed more than a 20% decrease, compared to women receiving placebo, in the risk of developing breast cancer.
Understanding the actions of hormones used for treating menopause symptoms and preventing disease due to hormone deficiency is complicated. Ms. Robson sticks with the story for use of estrogen to stop her chest pain and describes a "syndrome" seen almost entirely in women which is severe chest pain but absolutely normal findings of tests of coronary arteries and heart function The symptom is scary but, as our cardiology research showed many years ago (Sarrel et al. Angina and normal coronary arteries. Am J Ob Gyn 1992;167:467-472), the treatment of choice is estradiol taken in a way that maintains stable levels of the estrogen.

September 5, 2014 - 7:54am
EmpowHER Guest
Anonymous (reply to Anonymous)

The WHI age group analyses were secondary and not part of the protocol; they were conducted AFTER the trials showed cardiovascular risks. No drug exists that both prevents and exacerbates the very same disease. Estrogen is thrombogenic and puts women into a hypercoagulable state, as seen in pregnancy or on oral contraceptives. Both of these entail cardiovascular risks - strokes, emboli, and heart attacks. Estrogen does not prevent heart disease.

I 100% agree about the breast cancer findings related to PREMARIN alone (20% reduced risk). However, Premarin is much weaker than human estradiol and contains a mixture of various estrogens that seem to be having more of a tamoxifen effect than a pro-carcinogenic effect. Comparative trials have shown that Premarin without a progestin increases breast density by a measly 1% whereas estradiol it's 5%. So WHI should not be misconstrued to make it seem as though "estrogen", categorically, prevents breast cancer.

I don't doubt Ms. Robson's chest pain response to estrogen. However that does not mean she was having angina or an acute coronary syndrome that just magically disappeared with estrogen "replacement". Perimenopause is a time of swinging and HIGH endogenous estradiol, and women complain of heavy flow, fibroids, painful breasts, moodiness, and palpitations. Perimenopause is also a time of low/absent progesterone. Normal, health female physiology before menopause requires BOTH hormones, not just estrogen. Awoman with a hysterectomy, such as Ms. Robson, is ill-advised to be taking any kind of estrogen without progesterone. It is risky, even in the absence of a uterus.

I refer you to the recent KEEPS trial publications which showed that neither Premarin nor transdermal estradiol halted the progression of atherosclerosis. There were no positive effects of carotid thickness or coronary calcium scores. Symptom relief and feeling of wellbeing are undeniable, but estrogen is not a health tonic or antiaging elixir.

September 25, 2014 - 12:29pm
EmpowHER Guest
Anonymous (reply to Anonymous)

Thank you so much for sharing! I have had unknown heart flutters & arrhythmia s in the last 4 months , usually after I am coming off of a stressful day at work or intense workout . Now I am very fit- do lots of cardio & weight training-great stats in my CBC blood work. No changes to routine or health. My internist prescribed a low dose losartan - to prevent stroke & wanted me to take anti anxiety as he believed my stressful lifestyle my inability to cope the cause. I certainly didn't feel like I wasn't coping. Just wanted to know what the heck was happening. So after a serious long lasting intermittent arrhythmia I went to the ER with no findings but to see a cardiologist. After ,MRI , stress test, echocardiogram, I thus far have a very healthy heart . Now - I HAVE started to have strong peri menopause symptoms in the last few months , including hot flashes. Tomorrow, I see the cardiologist for my final assessment after wearing a 30 day event monitor . I hope he listens & incorporates my hormone imbalance!

September 4, 2014 - 8:57pm
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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.


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