Healthbeat Report: The Estrogen Effect

August 26, 2010 (CHICAGO)

While the research is in its early stages, doctors say the findings may be significant.

Virginia Jackson is a grandma on a mission. Her family, and especially her grandchildren, keep her moving.

"I take an active part. I do a lot. I go overboard," said Jackson.

But last April the 58-year-old go-getter got the shock of her life. She felt sick and passed out. A trip to the emergency room revealed she had a brain aneurysm. The bulge was in a weakened artery behind her right eye. If it burst, her life could be in jeopardy.

"They said it looked like I was having a seizure or something," said Jackson.

Dr. Michael Chen, a neurointerventionalist at Rush University Medical Center, flagged Jackson's case.

"The aneurysm measures almost a centimeter," said Dr. Chen.

She fit a profile researchers at Rush University Medical Center were looking for. Jackson was around menopausal age. She also claims to have never used oral birth control or hormone replacement therapy. So at different times of her life Jackson's body probably experienced fluctuations in estrogen levels.

The question: do those hormone changes explain why brain aneurysms are more frequently found in menopausal women?

Estrogen's effects on the cardiovascular system include a mix of positives and negatives but it's generally known to promote blood vessel health.

"Perhaps when there may be a drop in estrogen but that may compromise the ability of blood vessels to remodel effectively and therefore lead to weakness in the wall of arteries and in aneurysm formation," said Dr. Chen.

For the Rush study, 60 women with ruptured or unruptured aneurysms were studied ages ranged from 31 to 80. Compared to the general population, the women were less likely to have used oral contraceptives or hormone replacement therapy. That would suggest stabilizing estrogen levels may provide some protection against aneurysm.

"I think this points us to a new sort of area that hasn't really been studied that well," said Dr. Chen.

While there is no cause and effect, other doctors agree this small study is provocative.

"Estrogen may have other roles that we haven't thought about before," said Dr. David Cohen, reproductive endocrinologist, University of Chicago Medical Center. "There is an association with how the vessel in the brain functions and estrogen. That we know. So that's why there is biological plausibility to this argument."

So what does this mean for now? Researchers say this small study offers no recommendations. The hope is the study will guide future research eventually leading to better prevention and treatments.

Virginia Jackson's aneurysm was repaired by filling in the weakened area with a coil. She's back home running the show and making plans to get on with living.

"Once you have an aneurysm and come through it, you think of things you wanted to do and never did," said Jackson.

Generally the risk factors for aneurysms include smoking, hypertension and excessive alcohol use.

As for the role of estrogen, doctors are now designing more studies. Keep in mind this new research offers no therapy recommendation. Women along with their physicians need to individually weigh the risks and benefits of any estrogen replacement treatments.

Michael Chen, MD
Title: Assistant Professor of Neurology, Neurosurgery and Radiology
Address: Rush University Medical Center
1725 West Harrison Street
Suite 1121
Chicago, IL 60612
Telephone: 312-563-2048
Fax: 312-563-2206

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