There is no cessation of the need for calcium intake after the age of sixty. Currently, the RDA does drop to 1,000 milligrams for women over sixty who are on estrogen therapy, because estrogen has proved to be effective in maintaining bone. Nonetheless, the need for calcium-rich foods in our diets and perhaps for calcium supplementation continues in later life.

In support of our bones, the National Osteoporosis Foundation (NOF) was founded in January 1986. It is a nonprofit health organization dedicated to reducing the prevalence of osteoporosis. The NOF is the foremost resource for women and for health-care professionals and organizations that are seeking the most recent medically sound information concerning the causes, the prevention, and the treatment of this disease which robs us of our strength and of our lives. Information on how to contact the NOF is listed in the Appendix.

Just as a building depends on its solid construction and on the strength of its beams and its girders to keep it upright and strong, so we depend on the strength of our bones to maintain our skeletons and, ultimately, our good health throughout life.

We shape our buildings: Thereafter they shape us.

Heart attacks were traditionally believed to be the illnesses of men, caused, some thought, by the stresses of their work lives. That might have made some sense. Heart attacks afflicted many men in their fifties and younger, while women lived longer and were rarely afflicted. Then, as men and women gradually gained longer lifespans, (women’s still exceeding men’s), women began to experience heart attacks in greater numbers, too.

Some said it was because we women had ventured out into man’s world, clambering successfully over some of the barriers that had sealed off the world of work, and so we had begun to suffer the same kinds of stresses that were causing coronary heart disease (CHD) in men. That always seemed to me to be a fallacious theory, inasmuch as I believe that there is no work more stressful than the combined roles of wife, mother, daughter, homemaker, and those dozens of other roles that millions of women traditionally fulfilled prior to entering the workforce in droves.

Obviously, I wasn’t the only person who felt that way. Researchers began to apply themselves to investigating why some women began to experience heart disease around their mid-sixties or early seventies, approximately ten years later than men. It was thought that menopause and our lack of estrogen production might be the culprit. So after many decades of research into CHD with clinical studies done only with men, research into CHD in women began.

Women rarely experience heart attacks prior to menopause. Research today suggests that estrogen offers some protection against the blockages that can develop in the blood vessels and cause heart attacks or strokes. Studies seem to point toward estrogen’s action upon the serum lipids in the blood. Early data demonstrates that estrogen increases the good‚ cholesterol or high density lipoprotein (HDL) and decreases the bad‚ cholesterol or low density lipoprotein (LDL) in the blood. This affords the blood smoother passage through our blood vessels, clearing out the plaque build-up that can block its way.

A heart attack occurs when the blood is blocked from reaching the heart; a stroke occurs when blood cannot reach the brain. Heart attacks and strokes take the lives of more than one million women in the United States and Europe each year. Heart disease is the number one killer of American women, with heart attacks taking the lives of two hundred fifty thousand women and another ninety thousand claimed by stroke. Research to learn how to reduce these numbers is vital.

There are a number of research programs in progress that examine heart disease in women. One important research program was conducted at Harvard. Thirty-two thousand nurses were studied for four years and led investigators to learn that women who took estrogen appeared to have half of the risk of fatal and nonfatal heart attacks. Many other important studies support this link between estrogen and coronary heart disease, yet this relationship has not been conclusively proven.

In June 1991, the United States Food and Drug Administration (FDA) Advisory Committee on Maternal Health gave ERT its official recommendation. It advised that ERT be made available to virtually all‚ postmenopausal women. This committee further ruled that the benefits of hormone replacement therapy are sufficiently clear so that pharmaceutical companies can submit applications for approval of new drugs which provide both estrogen and progestin in a single application.

All of this information is offered up in a singularly confusing scientific environment, one that is confusing to physicians as well as to women. Critics of hormone replacement therapy abound, basing their concerns largely on the fact that long-term effects of the combined therapy are still unknown. That is because most of the research has been done with estrogen alone, although estrogen and progestin therapy combined has been prescribed widely in the United States for the woman whose uterus is intact.

During the summer of 1991, interim results of the Harvard Nurses Study were released suggesting the car-dio-protective effect of estrogen. Now at the ten-year halfway point in this ongoing study of more than a hundred twenty thousand nurses questioned by mail at regular intervals, the results so far have shown that women who go through early menopause (before age forty) or through surgical menopause (before forty) have a significantly higher risk of heart disease. This finding appears to link the functioning ovary and its hormones to heart health.

Of course, there are also many studies on the heart-healthy effects of good nutrition, exercise, stress reduction, and quitting smoking. These life-style factors are discussed in Chapter 13, and they are life-style choices that you can and should make now.

The question of the effect of ERT on coronary heart disease is not fully or finally answered although the implications are becoming clearer so this chapter can address the women’s questions only by sharing the information that appears to be known at this time.

Does ERT reduce the risk of heart attack? Even though research findings point to a significant positive relationship between estrogen use and a reduction in heart disease, no estrogen product has been approved at this time by the FDA for the prevention of heart disease in postmenopausal women.


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