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[KarineT]

If you refuse to believe that a lack of estrogen contributes to diseases, then there's not much more to be said really. There is now endless research that it does contribute to all kinds of health conditions and no one is even debating that.

What does it matter if menopause is a 'natural' part of ageing? Death is also 'natural'. So is cancer. So is suffering. 'Natural' doesn't mean 'good' and we need to stop equating these two words. Women didn't even live past the age of 60 until about the turn of the century, on average - that was 'natural', too.

As for whether or not it's a disease, I can't see that that really matters. It's a physical process which speeds up ageing and other diseases. So whilst not being a disease in itself, it's something it's desirable to address medically. There are many other changes the body goes through as it ages which are not 'diseases' but can be treated and reduced. And, in fact, many researchers do consider ageing itself to be a disease which one day we will understand better and be able to largely prevent.

Of course there are women past the menopause who don't have heart disease and dementia. Just like there were many people who smoked 60 a day and didn't get lung cancer. It's not evidence that something is okay just because you can come up with some unaffected people... That's why we have science and research.

I have never said that 'natural' means pleasant. I see the menopause as a phase like puberty.  The only difference is that the menopause symptoms last longer.  Can a lack of oestrogen be compared to, say, a lack of cortisol? I don't think so. Although hormones are important, a lack of cortisol is life-threatening but I'm not so sure about a lack of oestrogen. If oestrogen is so important, what about a lack of testosterone in men? Does research say that it contributes to diseases in men?  I've never come across an article that it doees. Why should it be different for women?  Is oestrogen more powerful than testosterone?

[joziel]

It's not really comparable to puberty, seeing that puberty enables us to be fertile and have a functioning body and mind and develop secondary sexual characteristics. Whereas menopause... doesn't do anything positive at all, except perhaps relieve people of periods. And does a lot of negative stuff, removing and reducing physical and mental functioning in so many ways - the opposite of puberty.

I don't understand the constant need to attempt to compare the lack of estrogen to other things. The lack of estrogen is a lack of estrogen. If someone had a broken leg, we wouldn't spend time comparing a broken leg to a broken arm. If someone had thyroid deficiency we wouldn't say 'well it compares like this to this other deficiency'. A lack of estrogen is a lack of estrogen - although menopause isn't just about estrogen but also about losing testosterone, let's not forget, and who knows there is even some thinking that progesterone plays a useful role in health as well.

Losing all our hormones isn't comparable to anything else. It doesn't matter if you think it's a 'deficiency' or a 'disease' state or a natural process, those are just labels. What matters is simply the effects that it has and whether these are desirable and whether they can be prevented.

Men do lose testosterone by the way and there is such a thing as TRT - testosterone replacement therapy. Where do you think Testogel, Testim and Tostran all come from? They are all made for men, to replace low testosterone from ageing. The only difference is theirs reduces slowly as they age, so they notice the effects less. And yes, low testosterone does contribute to many diseases in men. You can read about them here, a quick google will bring them up: https://www.healthline.com/health/side-effects-of-low-testosterone

Finally you still seem to be caught up in a binary thinking that estrogen is about women and testosterone is about men, which is really inaccurate. For the record, the NORMAL male ESTROGEN level is from 20-242nmol. Which, at the higher end, is the same as many women trying to replace their estrogen with HRT.

[laszla]

If you refuse to believe that a lack of estrogen contributes to diseases, then there's not much more to be said really. There is now endless research that it does contribute to all kinds of health conditions and no one is even debating that.

What does it matter if menopause is a 'natural' part of ageing? Death is also 'natural'. So is cancer. So is suffering. 'Natural' doesn't mean 'good' and we need to stop equating these two words. Women didn't even live past the age of 60 until about the turn of the century, on average - that was 'natural', too.

As for whether or not it's a disease, I can't see that that really matters. It's a physical process which speeds up ageing and other diseases. So whilst not being a disease in itself, it's something it's desirable to address medically. There are many other changes the body goes through as it ages which are not 'diseases' but can be treated and reduced. And, in fact, many researchers do consider ageing itself to be a disease which one day we will understand better and be able to largely prevent.

Of course there are women past the menopause who don't have heart disease and dementia. Just like there were many people who smoked 60 a day and didn't get lung cancer. It's not evidence that something is okay just because you can come up with some unaffected people... That's why we have science and research.

100% and there are even moves towards the WHO classifying ageing itself as a disease rather than a 'natural', inevitable process.

[Erika28]

My view is that HRT is good for some and those who want to take for as long as they live is their right.

But let's face it.  Menopause is a natural part of ageing for women and it should be accepted as that. I understand that we have symptoms and they can be horrible at times, I, myself, am not symptom-free, but we shouldn't try to medicalise the menopause because it's not a disease. Thyroid dysfunction is and it can cause serious problems, same as an adrenal disorder, which is potentially fatal if not treated.

As for all the health risks associated with a lack of oestrogen such as osteoporosis, heart disease and dementia, I know a lot of ladies who don't have these and they are well past the menopause.  I believe that, as men and women age, there are inevitable physiological changes in the body as we age, allowing for potential disease to develop, there are also a hereditary factor and an element of luck of whether we will develop any of these diseases or not.  I refuse to beleive that a lack of oestrogen contributes to diseases and I get the impression that the menopause takes the blame for everything.

Shelton, E. K. (1954). The use of estrogen after the menopause. Journal of the American Geriatrics Society, 2(10), 627-633.
"The final argument that the menopause is a natural phenomenon and should not be tampered with, is to me the most vapid of all. (...) The very person who argues that the menopause is a natural phenomenon fights nature very day. He pasteurizes his milk, boils his instruments, vaccinates his stock and his children, sprays and buds his fruit trees, flies against gravity, makes new elements and splits the atom. Is the menopause any different?"

Wilson, R. A. (1966). Feminine forever. New York: Evans.
"It has been argued that the extension of a woman's femininity by means of estrogen is ''interfering with nature". One might counter such objections by asking whether curing the measles----or any other disease---is also interfering with nature. If so, the art of medicine as a whole would have to be abandoned. I have never been able to elicit from these glib critics whether they consider "interfering with nature" merely inadvisable or outright immoral, and, if so, for what reasons. If such arguments were carried through, mankind would have to give up all efforts at healing, along with, for example, all types of farming-another form of interfering with nature. It is noteworthy, by the way, that the very origin of human civilization lies in the kind of interference with nature that led to the development of agriculture."

[Erika28]

Thirdly - 500 mg  prometrium is a HUGE dose. No gynae or menopause specialist would prescribe this amount (except for fertility indications). I'm amazed you've been able to function at all! I would be more worried about this in terms of potential increased breast cancer risk then the tiny amount of estradiol you are now taking.

I've not come across any studies showing an increased risk with bio-identical progesterone, only with progestins.

Climacteric. 2020 Jun;23(3):226-228. doi: 10.1080/13697137.2020.1735797.

"In the Lancet paper, they state that, in general, the relative risks did not vary by progestogen type, including oral micronized progesterone, although the risk appeared to be somewhat lower for dydrogesterone. But users of estrogen plus dydrogesterone comprised just 2.1% of HRT users, and users of estrogen plus oral micronized progesterone comprised only 0.4%. It is therefore impossible to draw any firm conclusions from these figures. The vast majority of combined HRT preparations contained medroxyprogesterone acetate, norethisterone acetate or levonorgestrel. "

Fourth - here in UK, the recommendation for women post 60 taking HRT is to use transdermal HRT ie patch gel or spray - because of increased stroke risk and cardio-vascular problems in older women, especially if you have other risk factors such as High BP, excess weight etc.

I've not come across any studies showing conclusively that oral bio-identical estradiol results in increased cardiovascular risk and increased blood pressure. Actually, the opposite of that.

Hypertension. 2005;45:399-405

“We studied 13 normotensive postmenopausal women (54±2 [mean±SE] years) before and after 1 month of oral estradiol 2 mg daily”

“In summary, in normotensive postmenopausal women, estradiol increases angiotensin II, but not aldosterone, at rest and during orthostatic stress, yet lowers, rather than raises, BP under both conditions. Downregulation of vascular and adrenal responsiveness to angiotensin II may protect healthy women against this activation.”

Circulation 76, No. 4, 753-758 1987.

“In the present study we found no change in systolic blood pressure and a tendency toward a lowering of diastolic blood pressure during both percutaneous and oral estradiol therapy. Exactly the same response has been reported during oral estrogen replacement therapy with higher estradiol doses*.27”

*4 mg oral estradiol vs. 2 mg in this study

Acta Obstet Gynecol Scand Suppl. 1975;43:1-11.

“Two different dosages of the oestrogen hormones were used: 4 mg 17-B-oestradiol with 2 mg oestriol, and 2 mg 17-B-oestradiol with 1 mg oestriol”

“The tablets containing oestrogen alone (E 42 and E21) were given with an intermission of 3-7 days between each treatment period, or in some cases with an intermission of 2 days each week.”

“The material comprised 352 patients, each of whom underwent 3 to 18 four-week treatment periods on one and the same preparation. The investigation covered a total of 2 101 four-week periods (Tables I1 and HI).”

“Neither thrombosis nor any rise in blood pressure occurred in any of the patients.”

“In menopausal women the blood pressure is often raised. During the treatment, if there was any tendency it was towards normalisation. In no case was an increase in blood pressure noted during the oestrogen therapy.”

Ann Clin Res. 1983;15 Suppl 38:1-121.

“Blood pressure, central hemodynamics and peripheral blood flow were measured at rest in 20 normotensive and 20 hypertensive postmenopausal women during cyclic placebo/estradiol-17 beta treatment. Micronized estradiol-17 beta was given in daily doses of 2 mg and 4 mg."

"Estradiol-17 beta substitution decreased the systolic and diastolic blood pressure in normotensive, hypertensive and borderline hypertensive postmenopausal women."

"Irrespective of the pretreatment blood pressure levels, heart rate decreased during estradiol-17 beta substitution”

[Erika28]

If oestrogen is so important, what about a lack of testosterone in men? Does research say that it contributes to diseases in men?  I've never come across an article that it doees. Why should it be different for women?  Is oestrogen more powerful than testosterone?

Yassin, A., Haider, A., Haider, K. S., Caliber, M., Doros, G., Saad, F., & Garvey, W. T. (2019). Testosterone therapy in men with hypogonadism prevents progression from prediabetes to type 2 diabetes: eight-year data from a registry study. Diabetes Care, 42(6), 1104-1111.

"Long-term TTh completely prevents prediabetes progression to T2D in men with hypogonadism and improves glycemia, lipids, and AMS score. TTh holds tremendous potential for the large and growing population of men with prediabetes and hypogonadism."

Lv, W., Du, N., Liu, Y. et al. Low Testosterone Level and Risk of Alzheimer’s Disease in the Elderly Men: a Systematic Review and Meta-Analysis. Mol Neurobiol 53, 2679–2684 (2016). https://doi.org/10.1007/s12035-015-9315-y

"Meta-analysis using random effect model showed that low plasma testosterone level was significantly associated with an increased risk of Alzheimer’s disease in elderly men (random RR = 1.48, 95 % CI 1.12–1.96, P = 0.006). Sensitivity analysis by omitting one study by turns showed that there was no obvious change in the pooled risk estimates, and all pooled RRs were statistically significant. This meta-analysis supports that low plasma testosterone level is significantly associated with increased risk of Alzheimer’s disease in the elderly men. Low testosterone level is a risk factor of worse cognitive function in the elderly men."

[KarineT]

Thanks everyone for your input but to me the menopause is not a disease.  That"s a phase that marks the end of a woman's reproductive life because the ovaries stop functioning after a while.  That's my view.  I was making a point when comparing oestrogen to cortisol because a lack of one can cause death while a lack of the other can't.  I don't think of the menopause in a negative way.  To me, the menopause diesn't mean the beginning of end.

[joziel]

Thanks Erika28 for that research, very interesting.

Karine, that's your opinion. Your opinion isn't based on the science or supported by it. There are still people out there who believe the world is flat. Their opinion is also not based on science or reality. Everyone is entitled to their opinion. Opinions aren't facts.

[KarineT]

Now if the menopause is not a natural phenomenon, what is it?  Why do we all go through it? 

[KarineT]

Well, Joziel I just have to hope that I won't get all the horrible diseases that exit because I haven't supplemented my body with HRT.

[McPeri]

Thanks Erika28 for that research, very interesting.

Karine, that's your opinion. Your opinion isn't based on the science or supported by it. There are still people out there who believe the world is flat. Their opinion is also not based on science or reality. Everyone is entitled to their opinion. Opinions aren't facts.

This is just rude. I thought this forum was to help and encourage each other. Clearly not, so I am afraid I am out ladies. The science is still developing and is encouraging, but not conclusive in all areas.

[joziel]

It's not rude  Several people have given a lot of evidence supporting their views here and even responding directly to what Karine has said. In turn, Karine doesn't accept the evidence or even engage or discuss it - and continues to hold the opinion she had before. In my opinion, that is more rude - because people have taken the time to find research papers and quotes, only to be completely disregarded.

She's perfectly entitled to believe whatever she wants to believe, of course, we don't live in a dictatorship. But what she believes isn't in keeping with the science and the research. That's not being rude, it is pretty clear from the perspectives in the thread.

[laszla]

It's not rude at all - on the other hand the blanket refusal to entertain the various evidence based research that is being cited here is bewildering

[Joaniepat]

It's not rude at all - on the other hand the blanket refusal to entertain the various evidence based research that is being cited here is bewildering

Well, you know the old saying, "You can lead a horse to water but you can't make it drink".
JP x

[KarineT]

There's no need to carry on having a dig at someone who wants to voice their opinion, even if what they say it's not back by science.  If a woman doesn't want to supplement her body with artificial hormones it doesn't make her more at risk of getting a disease than someone who does.