estrogen replacement therapy

Estrogen Replacement Therapy: Another blow for estrogen therapy

Estrogen replacement therapy (ERT), once touted as a health and fitness panacea for women after the menopause, continues to lose credibility on all fronts.

With its benefits for bone uncertain and its harms – more breast cancer and cardiovascular disease – confirmed, it now seems that estrogen replacement therapy (ERT) offers only minimal advantages for postmenopausal muscle.

Researchers from Australia investigated the effects of estrogen replacement therapy (ERT) on 840 healthy 70-79-year-old white women. Of these, 259 were taking either estrogen alone or estrogen-plus-progestogen. In particular, they wanted to find out whether muscle composition was superior in estrogen replacement therapy (ERT) users and whether this translated into enhanced muscle strength and physical function.

Estrogen is thought to affect muscle composition both directly and indirectly – the latter via its role in regulating carbohydrate and fat metabolism, which involves conserving muscle glycogen and stimulating the conversion of fat to energy.

The theory suggested that the estrogen users would have superior muscle composition in comparison with non-users, with greater muscle mass, higher muscle density and lower fat mass, giving rise to higher levels of muscle strength and physical function.

As well as assessing muscle composition, the researchers tested the women’s handgrip and knee extensor strength. They then measured physical function by means of repeated chair stands, walking and balance tests. estrogen replacement therapy (ERT) users were found to have greater muscle mass in their quadriceps (front thigh muscles) than non-users. They also had greater grip strength and marginally better knee extensor strength.

However, these improvements were very modest, at 3.3% or less. More importantly, they did not lead to enhanced physical function because the subtle differences in muscle composition and strength appeared to have no measurable effect on physical performance tasks.

The researchers concluded that ‘estrogen replacement has at best a minor association with muscle composition and strength, and these associations in well-functioning older women are of questionable clinical relevance’.

The bottom line for postmenopausal women seeking to boost their muscle power is that the skeletal muscle benefits derived from resistance exercise far outweigh any effect likely to be achieved with estrogen replacement.

Med Sci Sports Exerc, vol 37, no 10, pp 17411747

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