Juliegee: Dr. Brinton repeatedly emphasized the fact that estrogen is an energy (glucose) modulator. Some women, not all, experience that loss of that estrogen more acutely with severe symptoms of hot flushes, cognition problems, insomnia, depression- a general inability to function. According to her, THOSE women are the ones who can benefit from HRT. She says there is a window for beginning therapy -when symptoms begin- that can provide benefit. There is no benefit in using HRT if a woman is asymptomatic OR beginning post-menopause. For women who had experienced cancer, HRT was not recommended..
Kitano: Julie, you're correct about the short-term. She stressed that it was not beneficial after menopause as the brain had already changed unless you were in a small minority of women still having menopausal cognitive symptoms. I guess I just must have interpreted that to be a short-term intervention at the first symptom of menopause. It would be interesting if she in fact thinks that asymptomatic E4 women would not be candidates for estrogen.
The estrogen receptor network becomes uncoupled from the bioenergetic system during the perimenopausal transition and, as a corollary, a hypometabolic state associated with neurological dysfunction can develop. For some women, this hypometabolic state might increase the risk of developing neurodegenerative diseases later in life. The perimenopausal transition might also represent a window of opportunity to prevent age-related neurological diseases.
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