Menopause: The Estrogen Replacement Dilemma

By Anita Romaniw

Menopause…just mention the word and immediately women cringe. For some, it's anticipated worry. For others, it's a living nightmare. And still others sail right through menopause, hardly affected. No matter one's experience, the question still lingers, "Should I take estrogen?" This question has become even more urgent in light of recent studies warning about the potential health risks of taking estrogen.

The decision to take hormone replacement therapy (ie. estrogen and progesterone) during and after menopause is difficult; there is your future health to consider. Common sense prevails: get informed and then make a choice. Let's take a look at some of the important "estrogen issues."

How Long Does Menopause Last?

Menopause can last three, five, or even up to ten years. This transition period is termed, "perimenopause." That is the time when your estrogen levels decline, possibly producing annoying physical symptoms like hot flashes, night sweats and mood swings.

During this time your delicate brain chemical balance is disrupted (there's lots going on!), affecting communication between brain and body. Hence, there is a very erratic and uncomfortable physical response.

The body will recuperate from its loss of hormones with time. However, permanent estrogen-sensitive tissue changes do occur in the vagina, urinary tract, skin and hair, resulting in dryness. Adding back lost estrogen is the only way to halt these changes.

The good news: there are some lifestyle choices you can make to help control menopausal symptoms…and make living through it much more comfortable.

Soy Products are Saviors

Soy products may help to prevent and alleviate menopausal symptoms like hot flashes, night sweats and mood swings. Soy products like tofu, soymilk, soy flours and tempeh produce plant hormones called phytoestrogens, which are weak versions of human estrogen.

Soy foods provide an "estrogen lift" to estrogen-sensitive cells, without raising the risk of breast cancer. Interestingly enough, most Japanese women who consume soy foods on a daily basis throughout the lifecycle, experience very little perimenopausal symptoms…and have lower breast cancer rates.

Herbs vs. Hormones

Various herbal products are touted to help provide symptomatic relief for annoyances like sleep disturbances, mood swings, skin and hair changes. However, they will not prevent the permanent tissue degeneration that occurs with falling estrogen levels. In other words, herbs will not halt bone loss or prevent plaque formation in blood vessel walls, which occur in the years following menopause.

Bone Loss

A woman's hips and spine are sensitive to bone loss in the five to ten years following menopause. Estrogen replacement will slow down bone destruction, helping prevent osteoporosis.

Daily exercise including strength training of the upper body, combined with 1200 to 1500 mg of calcium, is an excellent protocol for prevention of bone loss. Strong muscles are essential to supporting bones well into the later years. The earlier in life you start, the better the long-term outlook. This combination of diet and exercise may greatly reduce one's dose of supplemental hormones required, if replacement therapy is chosen.

Heart Disease

The number one cause of death in North American women is heart disease. Estrogen plays a role in protecting pre-menopausal women from heart disease. In the presence of estrogen, the liver produces more good cholesterol and less bad cholesterol, along with preventing plaque formation in the blood vessel walls.

Following menopause, the profile is reversed, placing women at greater risk for high cholesterol and heart disease. While hormone replacement therapy will slow the cardiovascular changes following menopause, a long-term commitment to sensible nutrition, physical activity and stress reduction will also reduce the risk.

Breast Cancer

Breast tissue is exposed to hundreds of estrogen cycles throughout a woman's lifetime. The estrogen receptors in breast tissue may make breasts particularly vulnerable to tumour development following menopause. After menopause, risk factors for breast cancer start adding up, while body defences against cancer naturally slow down. With age, the enzymes responsible for repairing cell damage get a little tired.

The question is, will replacing estrogen increase one's risk of breast cancer? Estrogen replacement may promote breast tumour development. However, the risk is more significant when hormone replacement therapy is taken for longer than five years.

Weight management throughout the lifecycle may play a significant role in maintaining breast health in the later years, given the direct link between estrogen levels and body fat. A plant-based diet, rich in antioxidants (fruits, vegetables, nuts, seeds) can be very effective in protecting the breasts. Exercise helps by lowering fat tissue, building muscle tissue and boosting the immune system, helping to stave off early cell changes.


Anita Romaniw, B.A.Sc., R.D.N., is the Community Nutritionist at the Upper Fraser Valley Health Unit, Abbotsford, British Columbia, Canada (604) 864-3400



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