At the time of menopause, each woman has a window of opportunity during which she needs to make the important decision of whether to take hormones. As the estrogen levels fall, her body begins to go through degenerative changes that accelerate her risk of heart disease along with the other changes we have previously described. The sooner a woman starts HRT after menopause, the fewer degenerative changes she will experience. If a woman waits 10 years to start HRT, the heart protection from estrogen is greatly diminished. The same applies brain protection; once brain cells have been lost, it becomes difficult to retrieve normal function. However, for protecting bones, estrogen is effective even when started after age 75.
However, I would like to stress that each woman is an individual and if there are no contraindications to trying hormones, consider trying topical estradiol for a year to see if you experience any improvements. I recall Cora, an 82 year-old woman who was brought to me by her daughter June. Cora had never taken hormones after menopause.
June said, “Mom has always been so vibrant, energetic and happy and she loved to do gardening. However, for the past six months she just sits in a rocker and stares at the wall. I’ve taken her to several doctors and they have all told me that everything’s normal but this is not normal for my mother! Is there anything you can do to help her?” I examined her mother and the only abnormal lab result was her lack of estrogen. I told June, “I’m not sure how much benefit we can expect to see but let’s try her on estrogen and see how she responds.” A mere three months later, now with therapeutic estrogen levels, June told me with excitement, “I have my mother back! She’s smiling and happy and back to her old self.” Cora taught me to never give up on a patient just because they are older. Everyone deserves a chance to be better. People deserve to be treated as individuals not as statistics on a bell-shaped curve. I challenge my patients to become the outliers who defy the odds and do better than expected!
Excerpt from “Outliving Your Ovaries” © 2012 by Marina Johnson MD. Dr. Johnson was a medical writer and pharmacist before medical school and utilized these skills to research 450 medical journal articles to develop her book. She has no financial conflicts of interest or ties to any pharmaceutical company. Her only objective is determining the most effective, safest therapy for patients.