One of the main issues surrounding menopause is that it coincides with a steady increase in heart disease among women -- it is often said that women have a “protection” from heart disease that they lose, seemingly along with their estrogen, around the time they undergo menopause.

But Duke cardiologist Kristin Newby, MD, notes that the exact link between the two has not been proven. “it could be that estrogen is an innocent bystander to a process that we haven’t discovered yet,” she says.

“In some ways I think we do a disservice by perpetuating the idea that women have this almost magical protection against heart disease up until menopause,” says Newby.

While estrogen debates may continue indefinitely, there is no controversy about the fact that women and men alike are developing heart disease at earlier ages than ever before -- and that women should adopt heart-healthy behaviors including healthy diet, regular exercise, stress management, and regular well visits to a doctor, in their twenties.

What’s a “Bioidentical Estrogen?”

Bioidentical hormone replacement can be a confusing term, because it can be applied to any non-estrogen substance (often available without a prescription) that is meant to relieve the symptoms of menopause.

These substances are often promoted as panaceas that provide the benefits of estrogen replacement without the risks, but a variety of groups -- including the American College of Obstetricians and Gynecologists (ACOG), the American Medical Association, and the Food and Drug Administration -- have released advisories that bioidentical hormone therapies may be no different from estrogen replacement therapies, in terms of risk.

Duke gynecologist Charles Hammond, MD, says that one of the major safety concerns of bioidentical hormone replacement therapy is that there is no regulation of the manufacture and marketing of these formulas.

“And there’s not one shred of good scientific research that shows these products are any safer or any better than estrogen."

"In fact, there have been a number of papers showing that they sometimes don’t contain the ingredients they say they do. so on the down side they may carry the same risk as estrogen, and on the ‘plus side’ they may not be worth a thing, because you don’t know what’s actually in it.”