Nexus - 0602 - New Times Magazine-pages

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The argument is made that deaths due to heart disease in ties and seventies have 45 per cent less heart disease than men in women are very uncommon prior to menopause, but that after the same age bracket. Women develop heart disease much later menopause deaths increase sharply. Oestrogen deficiency is than men—seven or eight years later. Women's risk rises continu- blamed for this increase. It is therefore recommended that all ously as they get older but there's no sudden increase with menopausal women should now be placed on HRT as a preven- menopause. We never catch up."* tive treatment, whether or not they have a history of heart disease. Menopause itself is thus perceived as a dangerous risk factor for | OESTROGEN DEFICIENCY AND HEART DISEASE the increasing incidence of heart disease. This neat argument has The corollary to the menopause/heart disease myth is that there women clamouring for oestrogen supplementation. But is it true? is a reduction of oestrogen at menopause. In fact, it is often erro- Professor Hugh Tunstall-Pedoe, a renowned cardiovascular epi- neously stated that the ovaries fail at menopause, resulting in an demiologist at the University of Dundee, Scotland, says emphati- oestrogen deficiency. This oestrogen deficiency is then attributed cally, "Absolutely not". According to him, it is a myth that the to a higher incidence of heart disease in the postmenopausal menopause is bad for women's hearts. "It is unarguable that risk woman. While women have been led to believe that this lack of of myocardial infarction (heart attacks) and coronary death is oestrogen during the menopausal years is the cause of a variety of lower in women than in men in middle ages. However, there isa | symptoms and potentially debilitating conditions, there is a grow- myth that risk in women is held low only until the menopause, ing body of evidence that disputes this belief. around age 50 years, when it rebounds, equalling and later sur- Dr Jerilynn Prior, a physician and professor of endocrinology at passing that in men." In an article published in the Lancet, the University of Vancouver in British Columbia, points out that, Professor Tunstall-Pedoe writes that the increased risk of coro- to date, there exists no study proving the relationship between nary heart disease (CHD) in women with premature or artificial oestrogen deficiency and menopausal symptoms and related dis- menopause, lipid changes at menopause, and observational stud- eases. "Instead," says Dr Prior, "a notion has been put forward ies suggesting a protective effect of HRT, all contribute to the that since oestrogen levels go down, this is the most important myth.* change and explains all the things that may or may not be related The myth implies that coronary deaths in women should accel- to menopause. So oestrogen treatment at t age of our under- erate more rapidly after the age of 50 and the rise should be spe- standing is premature. This is a kind of backwards science. It cific to heart disease. However, Professor Tunstall-Pedoe's analy- leads to ridiculous ideas—like calling a headache an aspirin defi- sis, comparing the rate of CHD ciency disease."° deaths per million women with the According to Dr Susan Love: rate for men, shows women's death "Making eggs isn't the ovaries' only rates do not surge after menopause " ce function any more than reproduction and, in fact, never catch up to those Estrogen deficiency at menopause is a woman's whole function. The of men. "There is no rebound accel- A ovary is more than just an egg sac. eration in risk in women at or after Isa myth created by drug It's an endocrine organ—an organ the age of 50 years," he says. companies to justify selling that produces hormones. And it pro- Professor Tunstall-Pedoe's research " duces hormones before, during and reveals that the reason the numbers of supplemental estrogen. after menopause. With menopause elderly women dying from CHD are Dr John Lee the ovary goes through a shift from a greater than the numbers of elderly : follicle-rich producer of estrogen and men dying from the disease is simply ft defa i, Hea heaeBaal eateap progesterone into a stromal-rich pro- t August 1998, p. 3 . that many more women than men live ducer of estrogen and androgen. to be elderly. Stroma is the glue that holds all the Professor Valerie Beral, a leading epidemiologist and head of eggs together. In the postmenopausal woman the ovary responds the Imperial Cancer Research Fund at Oxford University, concurs with increased production of testosterone as well as continued that there is no evidence for a change in CHD pattern around lower levels of the estrogens, estrone and estradiol, and the estro- menopause, but the idea is nonetheless widespread. "It's sort of gen precursor, androstenedione."’ grown up as a myth along with the idea that therefore giving HRT So, contrary to popular belief, the ovaries do not shrivel up or will protect you...the idea that it's [HRT] going to protect women cease functioning at menopause. Ovaries continue to produce in the long term from coronary disease, which is the main reason hormones, including oestrogens, throughout the life cycle, though it is often given—there is really no basis for that." the amounts they produce change depending on a woman's age. Dr Susan Love—breast surgeon, an adjunct associate professor It is an erroneous belief that the ovaries cease producing oestro- of clinical surgery at UCLA, director of the Santa Barbara Breast gen at menopause. Since the menopausal woman is no longer in Cancer Institute and a leading author—agrees. "Heart disease is her reproductive cycle, it is not necessary for the body to produce not a symptom of menopause. Heart disease is heart disease. It is the high levels of oestrogen required to mature an egg. Therefore, more common in women than in premenopausal women but that's as women age, the ovaries grow smaller, as Nature intended. because postmenopausal women are older than premenopausal However, the part of the ovary that shrinks is known as the 'theca’, women. It's like gray: you're more likely to have gray hair after the outermost covering where the eggs grow and develop. The menopause than before it, but menopause doesn't cause gray innermost part of the ovary, known as the ‘inner stroma’, actually hair—rather, they both tend to happen in later life. becomes active for the first time in a woman's life. With exquisite "The standard line has always been that women are protected timing, one function starts up as the other winds down. from heart disease as long as their bodies make oestrogen, and Dr John Lee, physician, author and critic of hormone replace- then after menopause they lose that protection and rates of heart ment therapy, explains: "Estrogen levels decline at menopause, disease for men and women become equal. But in fact, the rates but not to zero. Estradiol falls generally to about 15 per cent of never become equal. In this country [USA], women in their six- pre-menopausal levels and estrone falls only to 40-50 per cent of ties and seventies have 45 per cent less heart disease than men in the same age bracket. Women develop heart disease much later than men—seven or eight years later. Women's risk rises continu- ously as they get older but there's no sudden increase with menopause. We never catch up."* 20 - NEXUS FEBRUARY — MARCH 1999