Hormone Replacement with Estrogen Improves Lung Function

January 02, 2017

Hormone Replacement with Estrogen Improves Lung Function 

 References: Pro Natl Acad of Sci, Townsend Letter, Menopause

 Did you ever wonder how women adapt to being pregnant? One of the key adaptations is that they have to breathe for two, and that's while their abdomen is being pushed up by the pregnancy. Can't you imagine breathing enough with a basketball under your belt? This question arises when I see a woman who has lung disease. Can we help her adapt to the challenges of that lung disease with hormones? And the answer is yes! 

This is particularly important because nonsmoking women actually have more chronic lung disease (called COPD) than non-smoking men. The first research came out in 1995 with the Drs Massaro showing that pregnant rats almost double their oxygen uptake ability. They do it in a unique way. They generate more and smaller alveoli than male rats, (the tiny air sacs where air exchange happens) leading to a greater surface area for oxygen to diffuse across. The same researchers then took immature rats and showed that their lungs made many more small alveoli when given artificial estrogen, compared to controls. So, it was estrogen that does it! 

 Testosterone in the same context didn't do it. And then, mature rats who had their ovaries removed lost lung surface area and increased the size of their alveoli, all leading to less oxygen capacity. The authors' conclusion was that estrogen plays a key role in lung function in female rats, and can result in regeneration of new and improvement in existing alveoli. This then lays the table for us to think about humans. The authors wrote a review article on estrogen and women with pulmonary dysfunction. 

Menopause becomes a critical risk period. With the loss of estrogen, alveoli decline and what may have been adequate prior to menopause because inadequate after. Considering how many women have chronic lung disease without even smoking, this becomes a critically important issue for the safe and optimal care of a post-menopausal woman, with any lung disease. The same applies for men. They need some estrogen too, and if their testosterone gets too low, their estrogen conversion doesn't happen enough to support lung function. 

 WWW. What will work for me? I've always considered estrogen replacement to be critical for brain and bone function. Then we added heart disease and reduced breast cancer risk. Now, it's clear that lung function is part of the mix. It only makes sense. What is part of your optimal healthy environment is still part of that combination when menopause arrives and estrogen declines. No wonder women with higher estrogen live longer. No wonder the Leisure Study found that women who use hormone replacement for over 15 years live the longest. I'm adding this to my armamentarium of reasons to be on BHRT. 

 Pop Quiz

1. Pregnant rats demonstrate markedly increase oxygen absorbing capacity. T or F?         Answer:    True 

 ‪2. Much of this increased capacity in pregnancy comes from smaller and more numerous alveoli? T or F?    

Answer:    Again, right on the mark ‪

3. Rats with ovaries removed recover more and better alveoli when estrogen is replaced. T or F?            Answer:  You are on a roll. Keep it up ‪

4. Humans also get better lung function when they are given estrogen after menopause. T or F?          Answer:  Again, true ‪

5. Which makes it obvious that the Leisure Study shows that women live longer when they are on hormone replacement. T or F?                Answer:  Perfect. A good start to the new year.