Why No Estrogen in Early Menopause is Risky Business

Why you can't afford to not take estrogen

Early Menopause causes a range of emotions. Mache Seibel

The symptoms of menopause can be very stressful for any woman. The hot flashes, poor sleep and low energy along with mood swings are a real nuisance. In this post I want to reach out to women who go into early menopause; for them the symptoms can be even more difficult and also carry more long-term risks.

First the bad news and really why I wanted to share this information with you. If you go into early menopause and don't treat it with hormone therapy, there can be up to seven times the risk of heart attack.

The lack of estrogen caused by early menopause reduces the flow of blood to the heart and that brings less oxygen to it. As a young woman with many years ahead of you, this is a very important issue.

Early menopause also plays a role in loss of bone and the development of osteoporosis or thinning of the bones. It can significantly increase the risk of a bone fracture as you age. Estrogen is important in keeping bones strong by preventing the cells called osteoclasts from taking calcium out of your bones at a faster rate. Estrogen is also helpful in putting calcium back in to bones by encouraging cells called osteoblasts to work more actively. As I point out in my book, The Estrogen Window, it's important to start estrogen close to the time of early menopause because your bones lose calcium most rapidly in the first 3-4 years after menopause and the longer you wait, the less likely it is that calcium can be restored to your bones after starting estrogen.

It's a good idea to get a bone density test as you enter menopause to know where you are at the beginning of the changes and get another one in one year to see how much it has changed.

If you remember the famous Women's Health Initiative study or WHI that was published in 2002 that said estrogen plus Provera could cause an increased risk of heart attack, breast cancer and stroke also found that those medications lower the risk of hip fractures in women after 3 years of treatment.

Women with early menopause are also at increased risk of mood swings and even dementia. As a matter of fact, women who go through early menopause and don’t take estrogen are at up to a 70% increased risk of developing Alzheimer's disease.

All of this can sound very scary. Many of the women I see with early menopause are already upset because their chances to have a baby are shortened or they feel old at a very early age. But there is good news. If you begin estrogen only if you have had a hysterectomy or estrogen plus a progestogen if you have a uterus and you do that at the time of early menopause, these potential problems can be almost totally eliminated. Here are some tips to further help you:

  1. When you do start estrogen, begin at a higher dose than is typically used for women in menopause. You are younger and will benefit from more. The exact dose has to be discussed with your doctor, but most women will do better with more than the lowest dosage. As you get older, this dosage can be lowered.
  1. Get a baseline bone density even if you are in your 30s. Over 45% of women who go into early menopause will have low bone density by the time they are diagnosed because their estrogen has been low leading up to early menopause.
  2. If your bone density is lower to begin with, talk with your doctor about adding testosterone to your estrogen. Testosterone helps to build up bone and muscle and that can be very helpful.
  3. Start your hormone therapy close to the time of menopause as possible to lower the risk of any of the problems I mentioned above. 
  4. Get emotional support. If you are feeling mood swings, anxiety or depression, you are not alone. Many women do with early or premature menopause. Getting additional information can be extremely helpful.

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