The Livelong Newsletter: Feature Edition

Good morning,

Annually, one million people will experience hormone loss caused by menopause. For these people, hormone replacement therapy (HRT) could be the answer to better quality of life—and longer life.

Dr. Bruce Dorr, a senior medical advisor for Biote, joins Livelong to discuss menopause, hormone replacement therapy, preventing disease, and longevity.

In today’s newsletter, you will learn:

• What is menopause?

• Why are hormones important?

• How does menopause affect mortality?

• Will you benefit from HRT?

• Why is HRT so controversial?

WOMEN’S HEALTH

Disease starts when hormone production stops

Millions of dollars are being poured into research to understand female reproductive health, as reproductive aging (loss of ovarian function and reduction in hormonal levels) may be directly linked with disease and mortality. 

“All of the diseases that either hurt us or kill us—heart, brain and bone disease—begin or are worsened with hormone loss,” Dorr tells Livelong.

Menopause is linked with some of the most dramatic hormonal changes that occur in a woman's life, which is why it has become a target for research and novel therapies that prevent the effects of hormone loss.

What is menopause? 

Menopause is a biological health condition that occurs when a person does not have a menstrual period for 12 months, according to Dorr. In effect, the ovaries are no longer releasing eggs for ovulation. 

Menopause is caused by a reduction in hormone production, specifically estrogen and progesterone. This leads to a host of emotional and physical symptoms that can be extremely uncomfortable and can last well beyond menopause (postmenopause).

Understanding menopausal symptoms

• Vasomotor symptoms

• Sleep quality

• Faster aging

• Emotional changes

Vasomotor symptoms: Hot flashes/night sweats

During menopause, a person experiences significant changes in estrogen production. According to authors of a paper published in the International Journal of Women’s Health, this affects neurons responsible for regulating body temperature.

Poor sleep quality

Years of VMS symptoms and other common symptoms can eventually lead to serious consequences, including poor quality sleep.

Long-term, poor sleep can increase the risk of cognitive decline and cardiovascular disease.

In fact, women in postmenopause are four times more likely to have a heart-related event, according to an expert in Wired. 

More rapid aging

The sudden hormonal changes also speed up aging, according to the expert in Wired. Menopause-related hormonal changes increase risk of:

• Metabolic diseases

• Depression

• Osteoporosis

• Dementia

• Faster cellular aging

Emotional changes

Menopause can lead to stark changes in mood and an increased risk of depression and irritability.

🥵STATS

Hot flash symptoms prevail

• 80% of people who go through menopause will experience VMS, Dorr says.

• The average duration of symptoms is 7.4 years.

• With this math, nearly 10% of a woman’s life could be spent dealing with VMS (based on a lifespan of 76 years, the average lifespan of a female in America).

Empowering long-term hormone health with HRT

As menopause is characterized by hormone loss, the most popular treatments involve keeping these hormones for as long as possible, or finding a way to reinvigorate the production of hormones. 

“If you think about it intuitively, putting back into the body the same hormones that were lost, and doing this with a delivery system that is as close as possible to that of the human body, is the ideal,” Dorr explains.

This is the aim of HRT.

When hormones are robust, many biological processes can continue to function accordingly and have a positive effect on longevity, Dorr says. These critical processes include:

• Metabolism

• Energy

• Sexual function

• Mentation (mental activity)

Advantages of HRT for lifespan:

• ❤️ It may cut risk of death from heart disease by 50%, according to Howard Hodis, a medical researcher at the University of Southern California who spoke with USC Today.

• 🧠 It may reduce brain fog, inflammation, menopause-associated changes, and risk of stroke and atherosclerosis (hardening of the arteries), Hodis said.

• 🛡️ It may protect against certain types of cancer (in women under age 60).

• 🦴 It may prevent bone loss and fracture*, according to the USC article.

• 🧬 Replacing estrogen can turn on longevity-related genes, according to a paper in Oxidative Medicine and Cellular Longevity.

• 🍊 Replacing estrogen may boost the expression of antioxidant-related genes, according to the paper in Oxidative Medicine.

_{*This could have indirect, but significant, longevity consequences, as breaking a hip after the age of 70 is fatal for 10% of women.}

Risks of HRT:

• There is low risk of developing breast cancer**, according to the NHS UK. The risk is greater for older women, previous breast cancer survivors, and with long-term use.

• There is a low risk of developing blood clots.

• There is low risk of having a stroke, moreso in women older than age 60.

Is HRT right for you?

HRT is most effective within 10 years of menopause, or in patients younger than age 60, Dorr said. It is particularly effective at reducing the risk of developing cardiovascular disease, which significantly increases post-menopause.

“The sooner that hormones are restored, the better,” Dorr says.

Patients who are older than age 60 should avoid HRT, as their risk of cardiovascular disease is already higher. HRT could worsen this risk (and it may also worsen risk of dementia in older patients). Women with a history of breast cancer are also cautioned to avoid HRT.

**One of the most famous and controversial studies linking HRT to breast cancer has since been debunked.

THE MORE YOU KNOW

Why is HRT so controversial?

• In a billion dollar-study from 2002, researchers linked HRT with increased risk of developing breast cancer.

• This study looked at HRT derived from estrogen in horse urine and medroxy-progesterone acetate (a type of birth control-like progestin), Dorr said.

• Upon reanalysis, there was no increased risk of breast cancer because women used HRT.

• Unfortunately, the “cancer-causing” label stuck around for the next 20 years. 

Note: “HRT and its risks are [still] based on which hormones you replace and what delivery system you use to replace the hormones,” Dorr says.

What are the different types of HRT?

• Some forms of HRT contain estrogen and progestin (or progesterone), and some are estrogen-exclusive.

• HRT can come as a tablet, gel, spray, patch, cream, vaginal ring, or other—the form may be determined by symptoms.

• HRT can be bioidentical to the body, which means it can mimic the chemical structure of hormones in the body, or it can be conventional (the FDA says conventional HRT is just as safe and effective).

• HRT can be taken cyclically or as a combined therapy.

Meet the expert

Dr. Bruce Dorr, senior medical advisor for Biote.

Thought this was interesting?

That’s great! Please take a second to share this newsletter with a friend. This way, we can continue to give you fresh, actionable, and evidence-based information that supports your health and well being.

🔔 Catch up on last week’s newsletter

We debunk intermittent fasting myths, discuss the healthfulness of airplane coffee, and much more.

We can’t wait to cover more trending topics in longevity in our next newsletter. Stay tuned.

-Erin

Longevity Media LLC

Be your own expert. Optimize your health. Look beyond conventional.

Always seek the advice of a physician or other qualified health care professional before starting any exercise, wellness, or health program. Nothing in our content, products or services should be considered, or used as a substitute for, medical advice, diagnosis, or treatment. Livelong is a media company and not a medical provid