Traditional thinking holds that a woman
is protected from heart disease and osteoporosis until
she goes through menopause.
But new research with monkeys questions that belief,
and suggests that the time to start protecting your heart
and guarding against bone loss is during perimenopause,
or preferably, even earlier.
"Most women think they don't have to worry much about
chronic health problems until perimenopause or menopause.
But there's a high-risk trajectory that women can get
on in their reproductive years that sets the stage for
later problems," said Jay Kaplan, head of the section
of comparative medicine at Wake Forest University School
of Medicine.
Kaplan said his hypothesis is that the quality of ovarian
function in the premenopausal period can contribute to
your health status later in life. He was scheduled to
present his theory and a review of previous studies that
support his hypothesis on Monday at the American College
of Veterinary Pathologists annual meeting, in Boston.
"Ovarian function varies quite a bit during the premenopausal
years," Kaplan said. "And it turns out that reproductive
function in both women and monkeys is easily impaired
by stress."
He said that women may not even realize their ovarian
function is impaired, because they still may cycle normally.
But that means these women are being exposed to varying
levels of estrogen, which can have an effect on your heart
and bone health, he added.
Perimenopause is the time leading up to menopause, which
is defined as not having had a period for 12 months. During
perimenopause, a woman's body starts making less of certain
hormones, such as estrogen and progesterone, and she begins
to lose the ability to become pregnant. Perimenopause
can start as early as age 35, according to the U.S. National
Women's Health Information Center.
In previous monkey studies that Kaplan had conducted,
he found that stress reduced estrogen levels and began
to cause the buildup of plaque in the blood vessels. Loss
of estrogen also contributes to a loss of bone density.
Dominant monkeys, Kaplan said, harass subordinate monkeys
continually. The constant stress caused by this harassment
reduces estrogen levels in subordinate monkeys, and reduces
their fertility levels as well, he said.
The same thing can occur in women in today's society,
Kaplan added. But they often won't realize there's a problem
unless they're having trouble becoming pregnant or sustaining
a pregnancy, he said.
The good news, Kaplan said, is that this loss of estrogen
is reversible if treated early on. One way to treat it
is to reduce stress, though that isn't always possible.
Another option is hormone treatment, he said.
Hormone therapy results from the Women's Health Initiative
were disappointing -- the study found hormone-replacement
therapy given to menopausal women could increase the risk
of breast cancer, heart attack and stroke, rather than
prevent illness. But Kaplan and others contend the trials
should have been done on younger women.
In another monkey study, Kaplan treated estrogen-deficient
monkeys with estrogen before they entered menopause. Doing
this helped prevent plaque deposits from building up on
blood vessel walls, thus protecting against cardiovascular
disease.
Trials of hormone therapy on younger women are currently
under way to see if early treatment of estrogen loss can
help maintain cardiovascular health, according to Kaplan.
Dr. Steven Goldstein, an obstetrician/gynecologist at
New York University Medical Center, and author of Could
It Be Perimenopause?, said, "The reality is a lot
of heart health begins before menopause."
"Perimenopause is an excellent opportunity to begin a
self-assessment and medical report card. Develop a plan
with your doctor for your overall health, diet and lifestyle
for the second half of your life. Perimenopause is a critical
time in women's health," he added.
Until more is known about the effects of earlier estrogen
therapy, Kaplan said it's a good idea to try to reduce
stress wherever possible.
"Stress does matter. In fact, it matters in ways that
women probably don't recognize. Try to learn new coping
skills for stress, and extend your social networks," he
said.
