Women's Health Over 60: Interview with Dr. Judith Reichman
I recently interviewed Dr. Judith Reichman about her latest book, "Relax, This Won't Hurt: Painless Answers to Women's Most Pressing Health Questions". Although, Dr. Reichman's book explores women's health during each decade from our twenties, to our seventies, and beyond, our conversation focused on an often, overlooked population of women&emdash;those who are over sixty.
Dr. Reichman is also the author of I'm Too Young To Get Old and I'm Not In The Mood; a regular contributor for the Today Show about various women's health issues including How to Get the Most Out of Your Doctor Visit; and a practicing gynecologist in California. We explored issues from hormone replacement therapy (including estrogen, natural vs. synthetic progesterone, and testosterone), hot flashes, to osteoporosis and exercise, and breast cancer risk, as well as what to do when symptoms occur.
Q: Should women over 60 continue taking estrogen if they have been taking it since menopause?
A: Basically, the issue of estrogen replacement once you are in your sixties&emdash;If you've been on it then you have given your bones a boost, and you have probably not lost 2 to 3 percent per year, in the first 7 to 10 years of menopause. But, the minute you stop taking the estrogen you fall back, literally fall back, to that same rapid loss of bone density. So that, if you've managed to stay on hormones since say your fifties, and you've now hit your sixties, and you stop your estrogen you will then restart the process of osteopenia or osteoporosis.
Q: Will a woman then return to the level she would have reached had she never taken estrogen?
A: It will within five years, probably be as if you did not take estrogen from the onset. And the other issue is that estrogen we feel protects you from coronary vascular disease. But, that protection is there as long as you take your estrogen.
Once you stop taking the estrogen then you again fall back to menopausal levels of HDL which falls and LDL which rises. And you also leave the protective effect of estrogen that occurs directly on your vessels, the lining of your vessels and plaque formation, and perhaps spasm of the vessels. So if we're giving estrogen for coronary vascular disease prevention or decreased risk once we stop it, we stop the protection.
Q: So, basically a woman would want to continue estrogen?
A: She would want to continue it, exactly. If she's benefiting then she will continue to benefit. As far as the benefits that have to do with memory loss there's more and more data showing that long term estrogen replacement may decrease Alzheimer's. In addition to the fact that there are many women who feel that once they lose their estrogen, their short-term memory diminishes. Now if we've managed to keep our short term memory with estrogen and then we stop it … we're going to go right back to a lot of the symptoms that might have started from the onset of menopause.
Q: Does that mean women who discontinue estrogen will return to hot flashes?
A: Yes they may definitely return to hot flashes. Vaginal dryness--we've protected with estrogen-- when we stop it we'll go back to vaginal dryness. What I'm saying is that when you take it in your fifties, when you stop it in your sixties you may go back to having symptoms.
Now some women won't. Some women will stop and they'll say, 'Oh, I'm not getting hot flashes. I feel OK, vaginal dryness is not an issue, I'm remembering pretty well, I have no family risk for Alzheimer's or coronary vascular disease, my cholesterol's are great and if I don't have symptoms, why should I take it?'
And if a woman is in that category-- she got the bone density and that looks OK, and she's doing everything right, she doesn't absolutely have to stay on the hormones. But, she should be monitored, her cholesterol's should be checked, her bones should be checked and she should see how she feels.
I mean there are no… What you learn in medicine are that there is no absolute black and white. The only absolute is that, unfortunately, at some point we all die.
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