When it comes to heart health, there are two questions concerning a woman’s natural estrogen: 1) does estrogen protect younger women from heart disease, and 2) whether estrogen’s decline at menopause contributes to heart disease in middle-age and older women. The simple answer: yes. But, as with many tight relationships, it’s complicated.
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Estrogen has a variety of biological effects, some beneficial and some harmful, Cleveland Clinic experts say. In the positive column, there’s quite a list including:
– Decreasing LDL (bad) cholesterol.
– Increasing HDL (good) cholesterol.
– Dilating blood vessels.
– Protecting against vascular injury.
– Inhibiting atherosclerosis (buildup of plaque in arteries).
– Aiding new blood vessel formation.
The negatives, on the other hand, include:
– Increasing triglycerides.
– Increasing inflammation.
Still controversial is whether estrogen increases blood clotting or prevents it. Overall, the evidence (and observation that premenopausal women rarely develop coronary artery disease) supports the theory that estrogen plays a protective role in young women.
But, everything changes at menopause. Estrogen levels drop by 90 percent and the type of estrogen in the body changes, with most now made by fat cells vs. the ovaries. This major hormonal shift contributes to the increased risk of coronary artery disease that begins soon after menopause.
Which begs the question, what about hormone replacement therapy (HRT)? No topic in women’s health has generated as much controversy and confusion as the role of HRT.
Cleveland Clinic experts conclude that HRT should not be used to protect the heart. But careful analysis reveals that HRT poses little to no risk when used for short periods (six months) by women who are within 10 years of menopause. In these women, HRT is effective at relieving hot flashes and night sweats. In contrast, in older women and those more than 10 years from menopause, HRT is riskier – it increases the likelihood of heart attack and death from heart disease.