Norimin (Norethisterine + Ethinylestradiol)
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HEART AT MENOPAUSE: STUDIES ON LINKS BETWEEN OESTROGEN AND HEART DISEASES
One recent study reported in The British Medical Journal in 1995 investigated the link between individual women’s own natural levels of oestrogen and their risk of heart disease. If the theory that oestrogen supplementation protects against heart disease is correct, it would be logical to assume that women with relatively high levels of oestrogen already in their bodies are at less risk of heart problems. The scientists studied 651 women, before and after the menopause, over a period of nineteen years, taking regular blood samples. They could establish no clear link between natural oestrogen levels and heart disease. They observed that death rates from heart disease did not change at the age of fifty and concluded that the different levels of oestrogen in pre- and post-menopausal women had nothing to do with the risk of heart problems, which suggests that oestrogen supplementation at the menopause is of doubtful help for prevention.
For most women hormone levels at the menopause reduce very gradually; for others there is a more dramatic change. At the moment there is no routine blood testing, even for those women who are prescribed HRT. I have seen women who have had a total hysterectomy (ovaries removed too) and then automatically been given a hormone implant. One woman later found she had 2.5 times the normal level of oestrogen in her blood. Were her oestrogen levels normal before she was given the implant? And would it have been more appropriate to monitor those levels before hormones were given? She is now being tested regularly as the HRT has been stopped, but her oestrogen levels are still too high. Our hormones do fluctuate, even after the menopause, but a hormone profile may still be worthwhile.
Until more is known about this it is clearly wrong to assume, as the advocates of HRT tend to do, that hormone deficiencies are the prime cause of all the symptoms and risks of the menopause.
So just what are the other factors that could give women an increased risk of heart disease beyond the menopause if the menopause itself and falling oestrogen levels are not to blame?
A pathologist named Jerome Sullivan in South Carolina, USA, posed the question why more men died from heart disease. He knew the prevailing theory was that oestrogen was protecting women but he had observed that women who had had a hysterectomy but kept their ovaries (which produce oestrogen) had a higher risk of heart problems. He asked himself what the difference was. He realized that women who have had a hysterectomy and post-menopausal women don’t have periods. Why would this make such a difference?
When we menstruate we lose about 500 mg of stored iron (ferritin) a year. Iron is a strange mineral. Until recently scientists thought the more iron we had, the better. Our bodies need iron to make red blood cells and to transport oxygen around the body. Without iron, new cells could not be produced and our organs would be starved of oxygen. The negative side is that we do not eliminate iron; it is continually stored as ferritin. The only time we lose iron is during a period, childbirth, an accident occasioning blood-loss or by donating blood. Sullivan found that by the age of forty-five a man has as much iron in his blood as the average woman of seventy. At these ages men and women share the same statistical risk of heart attack. They also have similar average amounts of ferritin in their blood. This, rather than oestrogen, might be the vital factor.
Jerome Sullivan published his findings connecting iron and heart disease in The Lancet in 1981, but the medical community was not impressed. They were still locked into producing drugs to lower cholesterol. It wasn’t until 1990 that a cardiologist called John Murray who had been studying nomadic African cattle herders realized that even though their diet was mainly whole milk, high in saturated fat and cholesterol, none of the men over fifty had heart disease. Whole milk is low in iron, so Murray proposed that cholesterol is only ‘bad’ when in the presence of iron’s oxidizing effects. He decided to measure cholesterol’s ’stickiness’ by giving the cattle herders extra iron for sixty days and found that, when he did so, more of the ‘bad’ cholesterol (LDL cholesterol) was produced in the body.
This idea is now gaining more recognition and a 1992 study in Finland, a country with one of the highest heart attack rates in the world, showed that high iron levels were a far better predictor of heart attacks than high cholesterol, high blood pressure or diabetes. Men with a ferritin level of 200 or more in this study had the greatest risk of heart attacks. There have been other contradictory findings in this area, so more research is needed.
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