Menopause, & When Not To Let Your Guard Down

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Today’s 30-Second Summary

If you don’t have time to read the whole email today, here are some key takeaways:

• Menopause affects more things than most people think, including serious threats to the bones, heart, and brain.

  • Today’s main feature looks at the benefits and (and for some people, risks) of HRT, as well as some important lifestyle considerations that make a very big difference.

• How’s your hydration right now? For most people, at any given time, it’s not great. But it doesn’t have to be that way!

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Tuesday’s Expert Insights

Menopause, & When Not To Let Your Guard Down

This is Dr. Jessica Shepherd, a physician Fellow of the American College of Obstetricians & Gynecologists, CEO at Sanctum Medical & Wellness, and CMO at Hers.

She’s most well-known for her expertise in the field of the menopause. So, what does she want us to know?

Untreated menopause is more serious than most people think

Beyond the famous hot flashes, there’s also the increased osteoporosis risk, which is more well-known at least amongst the health-conscious, but oft-neglected is the increased cardiovascular disease risk:

What Menopause Does To The Heart

…and, which a lot of Dr. Shepherd’s work focuses on, it also increases dementia risk; she cites that 60–80% of dementia cases are women, and it’s also established that it progresses more quickly in women than men too, and this is associated with lower estrogen levels (not a problem for men, because testosterone does it for them) which had previously been a protective factor, but in untreated menopause, was no longer there to help:

Alzheimer’s Sex Differences May Not Be What They Appear

Treated menopause is safer than many people think

The Women’s Health Initiative (WHI) study, conducted in the 90s and published in 2002, linked HRT to breast cancer, causing fear, but it turned out that this was quite bad science in several ways and the reporting was even worse (even the flawed data did not really support the conclusion, much less the headlines); it was since broadly refuted (and in fact, it can be a protective factor, depending on the HRT regimen), but fearmongering headlines made it to mainstream news, whereas “oopsies, never mind, we take that back” didn’t.

The short version of the current state of the science is: breast cancer risk varies depending on age, HRT type, and dosage; some kinds of HRT can increase the risk marginally in those older than 60, but absolute risk is low compared to placebo, and taking estrogen alone can reduce risk at any age in the event of not having a uterus (almost always because of having had a hysterectomy; as a quirk, it is possible to be born without, though).

It’s worth noting that even in the cases where HRT marginally increased the risk of breast cancer, it significantly decreased the risk of cancers in total, as well fractures and all-cause-mortality compared to the placebo group.

In other words, it might be worth having a 0.12% risk of breast cancer, to avoid the >30% risk of osteoporosis, which can ultimately be just as fatal (without even looking at the other things the HRT is protective against).

However! In the case of those who already have (or have had) breast cancer, increasing estrogen levels can indeed make that worse/return, and it becomes more complicated in cases where you haven’t had it, but there is a family history of it, or you otherwise know you have the gene for it.

You can read more about HRT and breast cancer risk (increases and decreases) here:

HRT: A Tale Of Two Approaches

…and about the same with regard to HMT, here:

The Hormone Therapy That Reduces Breast Cancer Risk & More

Lifestyle matters, and continues to matter

Menopause often receives the following attention from people:

1. Perimenopause: “Is this menopause?”

2. Menopause: “Ok, choices to make about HRT or not, plus I should watch out for osteoporosis”

3. Postmenopause: “Yay, that’s behind me now, back to the new normal”

The reality, Dr. Shepherd advises, is that “postmenopause” is a misnomer because if it’s not being treated, then the changes are continuing to occur in your body.

This is a simple factor of physiology; your body is always rebuilding itself, will never stop until you die, and in untreated menopause+postmenopause, it’s now doing it without much estrogen.

So, you can’t let your guard down!

Thus, she recommends: focus on maintaining muscle mass, bone health, and cardiovascular health. If you focus on those things, the rest (including your brain, which is highly dependent on cardiovascular health) will mostly take care of itself.

Because falls and fractures, particularly hip fractures, drastically reduce quality and length of life in older adults, it is vital to avoid those, and try to be sufficiently robust so that if you do go A over T, you won’t injure yourself too badly, because your bones are strong. As a bonus, the same things (especially that muscle mass we talked about) will help you avoid falling in the first place, by improving stability.

See also: Resistance Is Useful! (Especially As We Get Older)

And about falls specifically: Fall Special: Be Robust, Mobile, & Balanced!

Want to know more from Dr. Shepherd?

You might like this book of hers that we reviewed not long back:

Generation M – by Dr. Jessica Shepherd

Take care!

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