The Great Estrogen Debate

If you're a woman, and also a pre-menopausal woman, there's something you should keep an eye on – estrogen (or oestrogen for you Brits out there). If you're in your 20s or 30s you might be thinking about other things, but keep it in the back of your mind. It's an evolving situation and the implications of what you decide when the time comes might be very big.

Hormone Replacement Therapy (HRT) – taking estrogen to ease some of the unpleasant symptoms of menopause – has been pretty controversial. There was a famous study, back in 2002, called the Women's Health Initiative (WHI), that dramatically was called off three years early because the study concluded that it was too dangerous. The research was a multi-year study, comparing estrogen hormone replacement therapy with a placebo. The women in the study taking estrogen were experiencing more heart trouble than the ones on the placebo and their risk of stroke, blood clots and breast cancer increased dramatically.

Thing is, although most doctors stopped prescribing HRT for their patients at this time, there were some women for whom the estrogen was a lifeline. One such woman is Cynthia Gorney, who recently wrote a New York Times Magazine article about HRT, and who suffered violent mood swings and depressive thoughts when she stopped taking estrogen in the early stages of menopause. (I know you're thinking – does Taron read anything other than the New York Times? Apparently not. But it's really good journalism!)

But what current research is starting to show is that it's when women take HRT that is really relevant. Gorney started taking estrogen when her menopause was beginning, but the average age of the women in the WHI study was 63, and the average time period between their menopause (technically defined as the last mensus) and the start of taking the trial medication was 13.4 years. There are a few other differences as well, including differences in the way the estrogen used in the WHI study was manufactured. It's really too lengthy and complicated to go into in this blog post, but if you want the details or would like to read the whole darn article, click here.

But I'll boil it down for you. The WHI study essentially told all of us women that we should not take HRT well after menopause has technically happened – the study proved that it can increase your risk of stroke, blood clots and breast cancer. But what it hasn't told us is whether HRT is actually not harmful if you do it early enough, and if, in fact, it can be beneficial, particularly for people who experience very severe symptoms.

One study that is looking at this is the Kronos Early Estrogen Prevention Study (KEEPS). It is following more than 600 women and comparing a group that has been post-menopausal for an average of 15 years and has been on estradiol or on a placebo with a second, younger group that is an average of three years post-menopausal. There are lots of other studies on the go as well, including those looking at the effects of estrogen on depression and dementia.

The implications of what these studies could show us are grand, as there are many theories out there that say taking estrogen at the early stages of menopause could help women to retain higher cognitive abilities and may even prevent Alzheimer's, as well as avoid some of the less-palatable side effects of menopause.

Scientists already know that estrogen improves and protects the brain when it is added to healthy tissue, making new cells grow and increasing what's called "plasticity" – or the brain's ability to change. It builds up the density and number of dendritic spines, which are the barbs that stick out along the long tails of brain cells and hook up with other neurons to transmit information. Interestingly enough, the thinning of those spines is a classic sign of Alzheimer's.

But when cells are sick or dying – even due to the natural ageing process – estrogen has the opposite effect. Which explains why it was likely to be so harmful to many of the women in the WHI study. This is one of my more serious blogs – but serious implications, my friends. One to definitely keep on eye on as research develops and we get older.


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