BFP Magazine

Cardio-vascular Health

Coronary Arteries, Estrogen

Estrogren Therapy helps fight Heart Disease

By Dr. W. Gifford Jones

Can any medication slow the aging process? Currently only one drug , estrogen appears to be helpful. In my clinical practice I am consistently amazed at how quickly estrogen transforms an aging vagina into one that looks like that of a sixteen year old girl. The change is so remarkable I've suspected for years that estrogen probably also has a beneficial effect on blood vessels. But I couldn't prove this suspicion. Now studies by a Harvard researcher indicate conclusively that estrogen effects coronary arteries in a positive way.

Dr. Graham Colditz is an epidemiologist at Harvard Medical School. He's convinced the use of estrogen does more for women than merely relieve troublesome hot flushes at menopause. Since 1978 he has studied 120,000 U.S. nurses between 30-35 years of age to determine the effects of long-term estrogen therapy. His conclusion? Women who undergo hysterectomy with removal of both ovaries double the risk of heart disease if estrogen is not prescribed fter surgery. Yet epidemiological studies reveal that only 70 per cent of women are given estrogen by their physician following a hysterectomy with removal of both ovaries. No increased risk is evident if one or both ovaries are conserved.

What about natural menopause? Prior to change-of-life the incidence of heart attacks is 0.1 per cent. After onset of menopause the rate increases seven times. But in the U.S. a mere 30 per cent of those who experience natural menopause receive estrogen.

How does estrogen help to prevent coronary attacks? Dr. Colditz says there are two kinds of cholesterol; the bad kind, low density lipoprotein (L.D.L.), and the good cholesterol, known as high density lipoprotein (H.D.L.). Researchers believe that H.D.L. helps to clear the circulation of excess cholesterol. Fortunately for women, estrogen helps to increase the level of high density lipoproteins. Normal levels of H.D.L. in elderly women range from 50-60 mg/dl, whereas elderly women on estrogen have levels between 70-80 mg/dl.

Dr. Colditz explains that the use of estrogen is a classic example of the risk/benefit equation. He agrees that estrogen therapy is associated with a slightly increased risk of cancer of the uterus and gallstones. But uterine cancer is a relatively rare disease striking about one woman in every 100,000. Also it is usually a low grade malignancy. Besides, women on estrogen therapy are monitored more closely so should postmenopausal bleeding occur a D.and C. is recommended immediately. This results in earlier diagnosis and a greater chance of cure.

Women who refuse estrogen often suffer from painful intercourse. Over the years I've seen many patients unable to indulge in sexual activity for 10 years or more when a few dollars worth of estrogen would cure the problem. But there's also a lethal side to the equation. Patients lacking in estrogen suffer increased risk of eventual osteoporosis, a thining of the bones that causes backache and sets the stage for hip fracture. One woman in three over the age of 75 dies from a broken hip. As well there is no debate that cardiovascular disease is the number one killer in North America. So women who agree to estrogen therapy have much in common with the market vendor who said, "What I lose on the bananas I more than make up for on the peanuts".

Dr. Colditz makes another interesting claim. He predicts there will be less emphasis on increased cholesterol levels as the cause of heart attacks in the future. Rather, evidence suggests that higher fibrinogen levels are linked to coronary attacks. Fibrinogen is a blood protein that causes excessive stickiness of red blood cells , aggregation of platelets and the formation of blood clots.

Dr. Tom Meade at Norwick Park Hospital in England reports that high levels of fibrinogen increase risk of coronary attack by 84 per cent in five years. But increased levels of cholesterol increase risk by just 42 per cent.

So why remove ovaries when this triggers cardiovascular disease? Surgeons have no choice when the organs are diseased. At menopause old ovaries no longer produce sufficient amounts of estrogen. And non-functioning ovaries left in place may become cystic or cancerous later in life.

I make one plea to specialists in internal medicine. Please refrain from taking patients off estrogen when their blood pressure is a little elevated. Dr. Colditz found no evidence linking estrogen to hypertension. Nor did his study show any relationship between estrogen and breast cancer.

Dr. Colditz's research proves a positive benefit to estrogen therapy for women. I hope it puts to rest fears shared by both the public and some physicians about the value of estrogen replacement therapy after the female menopause. 

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of The Harvard Medical School. He's been a ship's surgeon, hotel physician and family doctor and later trained in surgery at McGill in Montreal, University of Rochester N.Y. and Harvard. His medical column is published by 60 Canadian newspapers and several in the U.S. He is the author of seven books. Dr. Walker has a medical practice in Toronto. His Web site is: He can be reached at

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