We propose that another factor may also contribute, one that has been overlooked - failure to consider the variable endogenous estrogen status of elderly women. Highly variable levels of estrogens are present in nearly all postmenopausal women, even at advanced ages. Similar to other endocrine systems, estrogen deficiency and the need for its replacement are, therefore, likely to be relative rather than absolute. Because many markers of estrogen deficiency exhibit overlap between risk groups, their clinical usefulness as predictors of frailty, disability, and response to HRT has been limited.
Future studies will need to focus not only on the use of highly variable circulating serum estrogen levels but also on markers of overall estrogenic effects at the level of individual target tissues i. We propose that a clinical approach that takes into consideration the remarkable heterogeneity physiological as well as psychological of elderly women will enable us to approach the decision about HRT in a more individualized and possibly better targeted fashion.
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The Estrogen Dilemma
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‘Anti-aging’ claims overlook scientific evidence on hormones
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That's a very big shift in thinking, based on the data which we reviewed from the Women's Health Initiative WHI hormone replacement randomized, placebo-controlled study. But there are other progesterones that are new generation, that have a lower risk of increasing breast cancer rates. They are being tested, but it's not yet fully known about their safety.
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That includes women who are obviously healthy and are newly menopausal, who are anywhere from late 40s to early 50s. The lesson from the Women's Health Initiative WHI is if you haven't had a period for more than 10 years, there are risks involved [with starting hormone replacement therapy] that are very hard to evaluate. Based on that, the group probably should avoid any hormone therapy unless there's a specific reason to introduce it. And second, we want to use the lowest effective dose. What we know is that again, back to the young woman in early menopause, the data say that for 10 years [after her last period], she is without an increased risk of either heart disease or breast cancer from the time her menopause starts for the next 10 years.