February 2023 Newsletter | Hormones and Health
My mission is to be the first woman in 4 generations to not develop Alzheimer’s Disease (AD). On my journey of discovering ways to mitigate my risk, I pass this information on to you in this Brain-Body-Health (BBH) Newsletter.
The month of love and hormones—dedicated to my nieces and all women coming into the age of perimenopause.
LESSONS FROM LIFE
With many loved ones coming into perimenopausal (PM) age and so much information coming out about why 2/3rds of Alzheimer’s Disease (AD) population are women, it’s a good time to talk about the chemical messengers that influence every part of the brain and body. I’m talking about testosterone in men and estrogen with progesterone in women. These sex hormones contribute to our mental, emotional, sexual, bone, vascular, and cognitive health. Menopause for women and andropause for men are different because there is an abrupt reduction in hormones for women causing problems like mood changes, depression, sleep, hot flashes, and cognitive impairment. For men, they have a more gradual decline over many years. For those of you who want more information on andropause (male menopause) or are non-believers, I refer you to my friend Dr. Jed Diamond, an expert in this field. For the discussion today I will focus on women and the link to AD.
First some history…While I was in medical school in the 1980’s Hormone Replacement Therapy (HRT) was the standard of care for all perimenopausal (PM) women. I still remember the Premarin (Estrogen derived from pregnant mares) advertisements in my father’s medical journals picturing a rocking chair holding a disheveled depressed woman transformed suddenly into a woman jumping for joy attributed to HRT. For several decades most women received HRT. This prescribing practice abruptly changed in 2002 with the news from the Women’s Health Initiative Study (WHI ) that there was an increase in breast cancer. Funded in part by donated Premarin from Wyeth-Ayerst Pharmaceuticals (WAP), this uptick in breast cancer was later determined to be due in part to synthetic progestin. However, the cat was out of the bag along with the sensationalism that lead to 70% of women stopping HRT, many of whom steadfastly still believe that estrogen causes breast cancer.
In 2002, I was going through an early peri-menopause at age 42 but the WHI scarred me and I stopped my HRT. Most of my friends refused HRT, preferring the “natural approach”. Meanwhile, I was suffering from depression, crying jags, loss of sleep, brain fog, and at a loss of what to do. Take hormones and die of breast cancer or suck it up and keep working and ignore my symptoms. Luckily, I found my way to a practitioner who restarted my HRT whereupon my symptoms improved. See LESSONS FROM SCIENCE as to why I continue HRT.
Unfortunately, much of the public and providers are stuck in the “retrograde” effects of the 2002 WHI study. Here is a 2015 follow-up report to the WHI, looking at women who took only Estrogen and not the Estrogen/Progestin portion of the study:
“The only statistically significant outcome for all participants (50–79 years) in the WHI Estrogen-Alone Trial for the 13-year cumulative long-term follow-up was a reduction in invasive breast cancer. There were no other statistically significant differences, including deep vein thrombosis (DVT), stroke, or hip fractures for cumulative long-term follow-up.” YEP, that’s right: a reduction of breast cancer.
LESSONS FROM COACHING
Science is a pointer for us, a pendulum always in motion leading us not blindly but in a direction worth considering and re-evaluating. There is no binary approach to deciding whether or not to take hormones. It is a highly individual decision based on your health, family/genetic history, and discussion with your healthcare provider. Caveat: Make sure your provider is skilled in current HRT treatment.
In the capacity of a health coach, I refer to providers who have knowledge of the current research about hormone usage during perimenopause. Most important is knowing what your family and genetic history tell you. If you’ve been reading this letter you know my mission is to be the first woman in 4 generations of mothers to not develop AD. Weighing my pros and cons of HRT, I am APOE4 positive, have a family history of AD, osteoporosis, and cardiovascular disease, and have no current medical problems or history of cancer. I remain on HRT with annual blood levels. For others, this decision may not be so easy. Whatever your leanings, your first move needs to be finding out if you carry the APOE 4 gene because of HRT's benefit in cardiovascular and neurodegenerative diseases.
If you are interested in HRT, I strongly recommend the book, Estrogen Matters, by Dr. Carol Tavris (Social Psychologist) and Dr. Avrum Bluming (Oncologist), and the podcast The Drive in which Peter Attia MD interviews the authors. In addition, this New York Times article provides an excellent overview of HRT.
LESSONS FROM SCIENCE
Brain imaging studies in menopause show neurons age quicker as estrogen decreases. See TED TALK with Lisa Mosconi, neuroscientist and author of “The XX Brain”.
Women with the highest rate of dementia are those that have had ovaries removed early in life.
This study shows HRT preserved vulnerable regions known to undergo the most significant decline in the earliest stages of Alzheimer’s disease.
Women are more likely to die from cardiovascular disease, osteoporosis, or dementia than from breast cancer.
For every one woman diagnosed over 60 with breast cancer, two are diagnosed with AD. The cure rate for early breast cancer is 90%; cure for AD ZERO.
Let’s not forget our science-based lifestyle practices that reduce our risk of AD: See BBH SLEDSS December 2022 Newsletter. Having a diet rich in phytoestrogens like flax, sesame, legumes, soy, and dried fruit, has also been reported to have benefits.
To our optimized health!
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To our optimized health!