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).
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
http://www.ncbi.nlm.nih.gov/pubmed/22663191
4. E-alone decreases verbal fluency in "younger" postmenopausal women
https://www.whi.org/researchers/Presentations/2013%20WHI%20Investigator%20Meeting/05%20-%20Vaughan%20-%20Long%20Term%20Effects%20on%20Cognitive%20Function%20of%20Postmenopausal%20Hormone%20Therapy%20Prescribed%20to%20Women%20Aged%2050-55.pdf
5. Combined testosterone and estradiol have no positive impact on cognition, verbal or spatial abilities
http://library.billingsclinic.org/ABOG2011/April/REI-Kocoska-Maras.pdf
6. Estradiol triples the risk of fatal stroke
http://www.ncbi.nlm.nih.gov/pubmed/11680444
7. Estradiol alone without progesterone increases both breast and ovarian cancer (French E3N study)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2211383/
http://www.ncbi.nlm.nih.gov/pubmed/21637986
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.
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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.
http://www.ncbi.nlm.nih.gov/pubmed/23169946
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
http://www.ncbi.nlm.nih.gov/pubmed/22663191
3. E-alone increases peripheral arterial disease, particularly abdominal aortic aneurysm.
http://www.ncbi.nlm.nih.gov/pubmed/16824852
4. E-alone decreases verbal fluency in "younger" postmenopausal women
https://www.whi.org/researchers/Presentations/2013%20WHI%20Investigator%20Meeting/05%20-%20Vaughan%20-%20Long%20Term%20Effects%20on%20Cognitive%20Function%20of%20Postmenopausal%20Hormone%20Therapy%20Prescribed%20to%20Women%20Aged%2050-55.pdf
5. Combined testosterone and estradiol have no positive impact on cognition, verbal or spatial abilities
http://library.billingsclinic.org/ABOG2011/April/REI-Kocoska-Maras.pdf
6. Estradiol triples the risk of fatal stroke
http://www.ncbi.nlm.nih.gov/pubmed/11680444
7. Estradiol alone without progesterone increases both breast and ovarian cancer (French E3N study)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2211383/
http://www.ncbi.nlm.nih.gov/pubmed/21637986
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 - 3:40pmThis Comment
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