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Dr. Sarrel introduces himself and explains how a woman's heart is affected by hormone replacement therapy.
Dr. Sarrel:
My name is Philip Sarrel. I work at Yale University. I started working at Yale in 1963, and in the 45 years that I have been there, there are several different programs that I started and have directed. My training originally was in the field of obstetrics and gynecology, but by the early 1970s, I became very much involved in understanding the psychological issues that women were presenting with their various GYN complaints.
This led gradually to a deeper interest in the field of cardiology, and starting in the mid 1980s, I became involved in a series of research projects that focused on women’s hearts and the way in which hormones work in women’s hearts. So I’ve had a career in gynecology, in initially obstetrics and gynecology, then weaving in the psychiatry, and then finally, for the last 20 years, focusing a great deal on cardiovascular issues and the importance of hormones in preventing problems that women can develop, especially after the time of menopause.
The two programs that I conduct at Yale right now, and I am phasing out of those programs, but one program has been the menopause program which we started, I started in 1976, and the sex counseling program, which my wife and I started together in the Department of Psychiatry in 1969.
The issue is a controversial issue. There is over 50 years of research indicating that estrogens made by women’s ovaries protect her from developing atherosclerotic disease, which is the background disease leading to heart attacks. There are many, many ways in which estrogens work in arteries and also work throughout the circulation and in the heart itself to protect women from having a heart attack.
One major study that we have, that is called The Women’s Health Initiative study, tried to determine to what extent treatment with estrogen would help prevent heart attacks, and in the first part of that study, it was found that there was no protective effect. In fact, given the hormone preparation that the women used, there was an increase, just the opposite of what we thought they would find.
I never thought that that part of the study would have a positive finding because it wasn’t an estrogen-only study. It was estrogen combined with another hormone that opposes the actions of estrogen. So it was no surprise that there were more heart attacks.
There is a second part, however, to the Women’s Health Initiative, which was for women who had no uterus, which in this country is millions of women, and who are at much greater risk for heart attacks than women who don’t have a hysterectomy, and in that study, the women who were given estrogen only over a period of almost seven years, from an average age of 63 to an average age of 70, there was a significant decrease in heart attacks.
So, the findings of 50 years are in fact corroborated by the Women’s Health Initiative studies but, for women who are within that decade from the time of their last menstrual flow, time of the menopause, and the following ten years.
Once you get into women in their 60s and 70s, then the Women’s Health Initiative estrogen-only did not show a protective effect. But in the younger women, to me a younger woman is in her 50s, and in her age group for sure, there was an important protective effect.
About Dr. Sarrel, M.D.:
Philip M. Sarrel, M.D., completed his medical education at New York University School of Medicine, his internship at the Mount Sinai Hospital, and his residency at Yale New Haven Hospital. In addition to his many years on the faculty of the Departments of Obstetrics and Gynecology and Psychiatry at Yale University School of Medicine, Dr. Sarrel has also been a Faculty Scholar in the department of psychiatry at Oxford University, Visiting Senior Lecturer at King’s College Hospital Medical School at the University of London, Visiting Professor in Cardiac Medicine at the National Heart and Lung Institute in London, and Visiting Professor in the Department of Medicine at Columbia University College of Physicians and Surgeons in New York. He is currently Emeritus Professor of obstetrics, gynecology, and psychiatry at Yale University.