Factors that influence the decision regarding hormone replacement therapy in postmenopausal women

Cardiovascular disease is the leading cause of death in women in the United States today. Prior to menopause women have lower rates of heart disease than men; however, after menopause a woman\u27s risk for heart disease rises dramatically. This is thought to be due the ovaries\u27 decreased production of estradiol, but the mechanisms for this effect have not been fully elucidated. The need exists to investigate the impact of healthy lifestyles on attenuating the risk of cardiovascular disease in women as they age. The majority of research on hormone replacement therapy (HRT) has focused on the biomedical model suggesting that menopause reflects an estrogen deficiency and is treatable by pharmaceutical intervention. Little information is available that views menopause from a broader perspective which includes psychological and social factors. This research tested the hypothesis that postmenopausal women who practice positive lifestyle interventions, such as health supporting diets and regular exercise, will demonstrate positive biological, social and psychological outcomes independent of HRT. Seventy healthy postmenopausal women, aged 48-66, who had experienced a surgical or natural menopause were categorized into one of three groups: (1) no hormone replacement therapy (n = 36); (2) estrogen only (n = 11); and (3) estrogen and progestin (n = 23). Subjects donated a fasting blood sample and completed a comprehensive lifestyle and medical questionnaire that gathered information regarding health, menopause, decision making, self-esteem, and mood states. Subjects also completed a food frequency and three-day food diary. Anthropometric measurements were performed to determine body mass index and waist hip ratios. Biological assays of collected blood samples included estradiol and progesterone concentrations, lipid profiles, serum beta-carotene and vitamin E in total serum and in LDL, total antioxidants and the resistance of LDL to oxidation. Results indicated that lifestyle factors including quality of dietary intake, duration and intensity of exercise, and body weight may be better predictors of disease risk than use of HRT in postmenopausal women. Results suggest that, regardless of hormone use, positive lifestyle interventions will provide improved quality of life in women as they age