Here is a post from my dear friend Dr Howard Elkin. The timing of his post was spot on as we had just gone over my latest blood work results.

I do my blood work at least twice a year and my previous results were from April. At 50 they showed a slowing down but nothing too drastic, my most recent results, however, put me right in menopause, all my hormones had taken a dive. Thankfully I actually feel pretty good, I have found myself worrying a little more but I put that down to some pretty major life changes this year (Moved to a different state, left my business in CA, had major surgery) I know so many women really struggle with this time of life and I certainly am not one to go down without a fight ūüôā

Here is the latest post by Dr Elkin, be sure to follow him on his blog


Most folks remember the results of the WHI (Women’s Health Initiative) released in 2002. Basically there was an increase in cardiac risk, blood clots and breast cancer in those using estrogen.However, what you might not remember is that the average age of the women in this study was 61 (making them clearly postmenopausal),an age where one would certainly expect to see heart disease. Also, the hormones used were equine estrogens,derived from the urine of pregnant horses. Most importantly all these estrogens were administered orally. Oral administration ensures that all drugs undergo the ” first pass ” effect in the liver, it’s been shown that many of these estrogens metabolize in the liver to inflammatory compounds..NOT GOOD

This study which has one disadvantage in being observational in nature, studied over 45,000 women over a period of 7 years. There was no increase in breast cancer , stroke or heart disease.

This is promising news. I have always prescribed topical /intra-vaginal estrogen for many years. Using bio-identical hormones, seeking hormonal balance, and knowing how to test HRT in an ongoing fashion is the key to safe hormone administration.

PHILADELPHIA — Vaginal estrogen use was found to be safe among postmenopausal women, researchers reported here.

In the prospective cohort study, Carolyn J. Crandall, MD, MS, of the University of California Los Angeles, and colleagues, found vaginal estrogen use was not associated with any increased risk for a global index event (GIE) (HR 0.69, 95% CI 0.59-0.81).

Presented at the annual meeting of The North American Menopause Society, the findings were similar among users with an intact uterus (HR 0.63, 95% CI 0.51-0.77) or who have undergone a hysterectomy (HR 0.83, 95% CI 0.63-1.08) after adjustment for age, education, prior estrogen use, and a history of cancer, CVD, or DVP/PE.

Crandall explained to MedPage Today that her group wished to conduct this study because there was an absence of long-term data of a large cohort of those who used estrogen vaginally.

Based on results from the Women’s Health Initiative, the¬†FDA requires warnings on all estrogen formulations.

She noted that “even the vaginal estrogens are required to have a black box warning that says ‘caution, increased risk of stoke, breast cancer, possible dementia,’ etc. And so currently, many leaders in the menopause field are wondering about whether that class labeling is unfair, essentially based on inadequate evidence, and they want to see whether that ought to be reconsidered.”

The prospective cohort study with data from Women’s Health Initiative Observational Study included 45,663 postmenopausal women age 50-79 from 40 centers. None of the participants used system estrogen therapy during the median 7.2 years of follow-up. Vaginal estrogen use was self-reported by the women and included use of a cream or suppository.

Crandall’s group also found no increased risk among individual cancer risks factors among the entire cohort of users with or without a uterus:

  • Breast cancer: HR 0.86, 95% CI 0.62-1.18
  • Colorectal cancer: HR 0.72, 95% CI 0.41-1.25

Similar findings were also reported regarding cardiovascular risk:

  • CHD: HR 0.44, 95% CI 0.29-0.69
  • Stroke: HR 0.63, 95% CI 0.40-0.98
  • PE/DVT: HR 0.59, 95% CI 0.33-1.05

Hip fracture risk was also not elevated among the entire cohort of users (HR 0.49, 95% CI 0.26-0.92).

The biggest take-home message from these findings is reassurance to clinicians regarding the lack of any increased associated risk for heart disease, stroke, of cancer among vaginal estrogen users versus non-users, Crandall highlighted, adding that she wasn’t particularly surprised to see these results.

Despite the several strengths of the study, including the large cohort, long follow-up period, and strict control of the variables, the findings are limited to the observational study design.

“Are those women using vaginal estrogen healthier for whatever reason, and that’s why they didn’t have heart disease and stroke and breast cancer? Maybe because they’re thinner, they exercise more, access to medial care — we tried to control for everything, but we can’t rule it out that there could be some systemic effect. I think that would probably be the one caveat of the study.”

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