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Rebecca Thurston is a superstar in the midlife women’s health research world.
Her work focuses on the impact of hot flashes on cardiovascular health. She is also a psychiatrist so she has an understanding from her patients of the full lived experience of perimenopause.
I was thrilled when I saw that Feisty Media’s Selene Yeager, host of the Hit Play Not Pause podcast, had interviewed Rebecca Thurston in a recent episode: Cardiovascular Disease & Brain Aging During Menopause with Rebecca Thurston.
Selene asks great questions and Rebecca Thurston has a wealth of knowledge.
Below, I share two questions Selene asked and Rebecca answered during their discussion, but I highly recommend listening to the whole podcast!
2 Important Questions Selene Asked
#1: How do we explain the relationship between hot flashes and cardiovascular disease risk?
Rebecca Thurston: When it comes to cardiovascular disease risk we’ve seen a couple of different things. What we think is that it’s either these earlier onset vasomotor symptoms that are happening relatively early in the menopausal transition and/or when they are happening persistently. Often times women who get them early tend to have them longer. So for example, we looked at in SWAN (The Study of Women’s Health Across the Nation) the risk for heart attacks and strokes over 25 years for women who had hot flashes. And what we found was that the women with the most persistent hot flashes over the course of the transition, these women were at the highest risk for heart attack and strokes over those 20 some odd years. Some other data that we looked at had pointed to these earlier onset hot flashes but it’s probably those real persistent hot flashers that start early and keep going.
Selene: Do we know why? Do we think that some women are more exquisitely sensitive to their hormones? Do we know why it’s connected to cardiovascular disease risk? Are they more sensitive to estrogen leaving the building?
Rebecca Thurston: So that is what we were trying to answer in MS Heart in part. What are the mechanisms that explain these? And the hormones did not seem to be the story. And we really measured these hormones well. We used these super fancy measures called mass spectrometry that get at the very very low levels that post-menopausal women have. We looked at two different estrogens in the body: estrone and estradiol. We looked at FSH. We looked at testosterone. We looked at the proteins that bind the hormones. The hormones were not the story. At least not levels of hormones and changes in levels. So that was really kind of interesting.
#2: What about hormone therapy for the prevention of heart and brain disease?
Selene (host): I have to ask, there is a lot of chatter around hormone therapy right now as a protective element for heart disease and brain disease and a lot of it bounces back to this research, people connecting their own dots.
Do you have anything to say on that?
Dr. Thurston: On hormone therapy, I mean the bottom line on hormone therapy is that it’s good for symptom management that’s pretty much what we use it for is to treat hot flashes and also topically to treat urogenital symptoms to treat vaginal dryness.
Those it’s really good for.
However, in terms of cardiovascular risk reduction or protection of brain health, the data from our randomized controlled trials do not support that. Right now the recommendations are hormone therapy should be to treat the vasomotor symptoms, not as a primary prevention of heart disease or dementia.
We went through this in the 90s. And we used to think that hormone therapy was good for all that ailed you.
And then, we did our randomized controlled trials and we were very surprised to see that things did not work out to show that benefit. In fact showed some increased risk, particularly in older women for both heart and brain.
Now I see the pendulum starting to swing back, where we really want to believe that hormone therapy is really going fully protect us. And the data just do not support that. As much as it would be lovely if that were true. And there is some risk that you need to take into account, whether it’s breast kind of risk and endometrial risk that you need to pair it with progesterone. So there are some real subtleties around hormone therapy so that it’s really important that if you are considering hormone therapy that you talk to your medical provider. And if you use hormone therapy you use FDA-approved and regulated formulations. Don’t try to go this alone. And beware of going into realms that are not supporting FDA-approved treatments. So it’s complicated and it needs to be really individualized. It’s not what we would recommend for first-line protection of heart and brain.
Selene: And to end this on an important note. All that said, do not suffer through symptoms. Right?
Dr. Thurston: Absolutely, if you are having lots of hot flashes, they are really getting in the way of your life and you are waking up in during the night, you are miserable, absolutely, do not suffer
In this discussion, Dr. Thurston refers to the work of her colleague Dr. Pauline Maki who focuses on brain health. Check out our discussion with Dr. Maki here.
