Janice is 49 years old, is married, and has two teenage children. Over the last year, her periods tended to be irregular and heavier than usual

Question

She also noticed intercourse was becoming more painful for her, and her interest in sex declined. She knew her mother was 51 when she reached menopause, and Janice was concerned about having the mood swings and hot flashes her mother had experienced. She phoned some of her friends to seek their advice. Some said she should try hormone therapy, while others said it was not a good idea at all. Other friends said she should use remedies like red clover tea and soy isoflavone supplements. Janice decided her best bet was to go to the local women's health care clinic to discuss her options with a nurse.

Using the data collected by the Women's Health Initiative and the Nurses' Health Study, why are some women at an increased risk for CHD and others are at a decreased risk when hormone therapy is prescribed?

Why are alternative methods like red clover and some plant oils being promoted for the menopausal woman? What are the changes that occur in a woman's reproductive organs when estrogen levels decline?

How does estrogen affect bone growth during puberty? Why are postmenopausal women at risk for osteoporosis?

Answer 1

The Woman's Health Initiative study indicated that women who began HT after 60 years of age or later than 10 years after menopause had an increased risk for CHD. It is thought that these women began HT with the preliminary development of atherosclerosis; the use of therapeutic hormones accelerated inflammatory cytokine activity that led to unstable plaque formation and the development of symptoms. When corrected for age and the time when HT was implemented, the WHI demonstrated that younger women (under 60) and women who began HT within 10 years after menopause received the cardioprotective benefits of the treatment. The Nurses' Health Study confirmed that, if started shortly after menopause, HT reduced CHD by 30%. Studies consistently show, however, an increased risk of thromboembolism in women using HT, particularly within the first 2 years of treatment.

It is thought that certain plant oils that contain substances similar to steroid hormones may be used as a natural supplement when human estrogen levels decline. Soy and red clover contain "phytoestrogens," which are also said to exert estrogen effects in the body when taken as supplements. Although the use of these products has increased, their effectiveness has not yet been demonstrated in clinical trials.

Declining estrogen levels have a variety of effects on the woman's reproductive organs. Subcutaneous fat declines and skin becomes less elastic, allowing the breasts to sag as tissue mass decreases. The ovaries, uterus, and cervix atrophy when not supported by estrogen. The production of cervical mucus also declines, leaving the vagina dry and prone to infection.
During puberty, estrogen is responsible for the accelerated growth of long bones and for initiating the closure of the epiphyseal plates. Estrogens also have the effect of antagonizing the actions of PTH; when estrogen declines in menopause, bone resorption accelerates. Women are therefore at an increased risk for osteoporosis after menopause.