10 Essential Takeaways From “Estrogen Matters”  By Dr. Michele Couri, MD, FACOG, ABIHM

Empowering Women with HRT Facts

By Dr. Couri, MD, FACOG, ABIHM

I recently read a book entitled “Estrogen Matters” by the oncologist Dr. Avrum Bluming and the social psychologist Carol Tavris, PhD that I found very insightful, and it validates my long-held opinions on hormone replacement therapy (HRT).  It presents a comprehensive argument in favor of HRT for women experiencing menopause.  It scientifically analyzes decades worth of data on HRT and translates a very complex topic into easy to understand facts.   Here are ten key points from the book:

1. Historical Context: The book discusses the history of HRT, including its rise in popularity and the dramatic decline following the Women’s Health Initiative (WHI) study in 2002, which raised concerns about the risks associated with HRT.
2. Reevaluating WHI Study: The authors argue that the WHI study was misinterpreted and that its findings were not applicable to all women. They assert that the risks of HRT were overstated while the benefits were understated.  What I found to be quite interesting is that the median age of the women in the WHI that were started on HRT was 63, 70% of the women were significantly overweight, and 50% were obese.  Nearly 50% were previous or current smokers, and more than 35% were hypertensive.  This is not the ideal population of women to be taking HRT in the first place.
3. Benefits of HRT: HRT can alleviate menopausal symptoms such as hot flashes, night sweats, and vaginal dryness. It also has positive effects on mood, sleep, and quality of life.
4. Cancer Risk: The book addresses the fear of breast cancer associated with HRT, presenting evidence that estrogen alone does not increase breast cancer risk and may even decrease it. The combination of estrogen and progestin may have a slight risk increase, but it is argued to be much smaller than previously thought.  In fact, in 2020, after nineteen years of follow-up, the WHI investigators reported a 23% decreased incidence of breast cancer among women randomized to estrogen.  In 2021, a WHI principal investigator reported that after twenty years of followup, women who received estrogen and progesterone had no statistically significant increase in breast cancer mortality, while women taking estrogen alone had a 40% reduced risk of death due to breast cancer.  
5. Cardiovascular Health: Estrogen has a protective effect on the heart and blood vessels, reducing the risk of heart disease, which is a leading cause of death in women.  There is now consensus that when women take HRT at the start of menopause or within the first 10 years of menopause, HRT reduces the risk of coronary artery disease and heart attacks.  
6. Bone Health: Estrogen plays a crucial role in maintaining bone density, thereby reducing the risk of osteoporosis and fractures in postmenopausal women.  HRT is a very effective option for the prevention of and for the improvement of osteoporosis.  HRT has been shown to reduce the risk of a hip fracture by 30-50%.  When women discontinue taking estrogen, the risk of hip fractures increases, and within 6 years, the risk is where it would have been had women never taken hormones at all.  
7. Cognitive Function: The authors highlight research suggesting that estrogen may have a protective effect against Alzheimer’s disease and other forms of dementia.  The WHI did not find an increased risk of dementia or cognitive impairment in women who took estrogen.  However in women taking estrogen and a synthetic progestin, the risk was slightly increased only if they had preexisting cognitive impairments or if they were starting HRT over age seventy-five.  Just like with cardiovascular health, there is a window of opportunity for starting HRT for cognitive benefit, and that is ideally within the first 10 years of menopause.  
8. Quality of Life: HRT can significantly improve the overall quality of life for many women, allowing them to remain active and engaged during their postmenopausal years.
9. Personalized Medicine: The book advocates for a personalized approach to HRT, taking into account individual risk factors, health history, and personal preferences. It stresses that one size does not fit all.
10. Advocacy for Informed Choice: Dr. Bluming and Carol Tavris emphasize the importance of informed decision-making, urging women to discuss HRT with their doctors and to consider the full range of scientific evidence rather than making decisions based on fear or misinformation.

These points encapsulate the book’s argument that estrogen is an important hormone for many women and that the benefits of HRT can outweigh the risks when used appropriately.  My only criticism of the book is that Dr. Bluming is not a fan of compounded HRT, something that I have found extremely safe and effective in thousands of my patients over the years.  If you want to empower yourself with the most comprehensive armamentarium of scientific facts on HRT, I highly encourage you to read Estrogen Matters.  

To Your Health,

Dr. Couri

In the interest of full transparency, it’s important to note that there are no financial disclosures associated with Dr. Couri’s blog post on “Estrogen Matters” by Dr. Avrum Bluming and Carol Tavris.  Dr. Couri’s endorsement is non-commissioned; she’s simply sharing her genuine passion for the book’s insights on estrogen and HRT for optimal health.

Sources Used:

Bluming, A. Z., & Tavris, C. (2018). Estrogen Matters: Why Taking Hormones in Menopause Can Improve Women’s Well-Being and Lengthen Their Lives – Without Raising the Risk of Breast Cancer. Little, Brown Spark.

Rossouw, J. E., Anderson, G. L., Prentice, R. L., LaCroix, A. Z., Kooperberg, C., Stefanick, M. L., Jackson, R. D., Beresford, S. A., Howard, B. V., Johnson, K. C., Kotchen, J. M., & Ockene, J. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women’s Health Initiative randomized controlled trial. JAMA, 2002.  288(3), 321-333.