HRT is Great, or is it?

Kate Mack Nutrition Educator September 20, 2002

THERAPIES TO DEAL WITH MENOPAUSE

So what is a woman to do? There are so many different therapies and ideas. Medically, nutritionally, herbally, emotionally and spiritually. So let’s look at some therapies that are available to use.

Estrogen Replacement Therapy

The decision to use estrogen for hormone replacement therapy is difficult. Providing relief from hot flashes as well as slowing down the rate of osteoporosis, versus the potential side effects such as increased risk of endometrial cancer and possibly an increase of breast cancer are issues a woman needs to think about. On July 9, the Woman’s Health Initiative abruptly halted a hormone replacement study because they found that the drugs caused a slight but significant increase in the risk of invasive breast cancer. Although the danger to an individual woman is tiny the drugs’ risks exceed their benefits. (San Francisco Chronicle, July 9,2001)

An estimated 6 million women take the drugs estrogen and progestin to replace the hormones lost at menopause. This is 38% of postmenopausal women. It was hoped that this study would prove that no only do the drugs relieve hot flashes, night sweats and vaginal dryness but that they improve women’s health overall. The study’s investigators reported that this did not happen. The directors of the study, known as the Women’s Health Initiative, sent letters to the study’s 16,000 participants telling them to stop taking their medications. The risk of breast cancer rose by 26% in women on the combined therapy for just over five years, while heart disease risk rose by 29% and there was a 41% increase in the risk of stroke. However, there were fewer colorectal cancers and fewer hip fractures reported. (San Francisco Chronicle, July 9,2001)

This study is a bombshell for those that once thought HRT was a way for women to remain forever young. However, the study did not address the question of estrogen alone, without progestin. The Women’s Health Initiative will continue a study of 11,000 women taking just estrogen since there is no evidence so far that the drug’s risks exceed its benefits. On July 17 there was another report on HRT. The Journal of the American Medical Association reported that in a study conducted by the National Cancer Institute 44,000 women taking estrogen alone where found to have a 60% higher risk of ovarian cancer than women who had never used estrogen. Those on the hormone therapy for 20 years or more were three times as likely to develop ovarian cancer as women who did not take it at all. (health.webmd. aol.com/condition)

So when did we discover this ”synthetic estrogen” that seems to be causing such a stir? During the 1940s and 1950s estrogen became a popular prescription for the symptoms of menopause. The book Feminine Forever, written by Robert Wilson, described in graphic detail how the lack of estrogen at menopause led inevitably to the shriveling of a woman’s body. Premain was introduced in 1949. It became the synthetic estrogen replacement hormone doctors would prescribe. By the time the 1970s arrived it became apparent that just taking estrogen alone caused the build up of the endometrial lining of the uterus, thus causing Uterine Cancer. Progestin (Provera) reduced this risk so physicians recommended a combination of both hormones. Wyeth-Ayerst maker of Prempro (an estrogen and progestin combination)) did study after study that supported estrogen’s role in keeping the cardiovascular system healthy. It was shown to lower LDL cholesterol. Since heart disease was emerging as the number 1 killer of women this made sales of Prempro hit an all-time high. (Murray, 1995: 110-111)

But once again doubts began to surface. This time multiple studies began to support an incontrovertible link between estrogen supplementation and breast cancer. This should not have been a surprise since estrogen is well known to stimulate the growth of estrogen-sensitive tissue, like that in the breast and uterus. In addition, a number of large studies challenged the heart-protection theory. Until the most recent findings from the study done by the Woman’s Health Initiative, doctors had strongly supported Prempro. However, now women and their doctor’s are left to question which is the best therapy for their symptoms of menopause.

Bioidentical Hormones

In contrast to Premarin and Provera, which are synthetic and non –bioidentical hormones, there are hormones that are exactly the same as those found in the female body. Though they are synthesized in the lab from hormone precursors found in soybeans or yams, their molecular structure is designed to be an exact match of the hormones found in the human body. They are called bioidentical (Northrup, 2001: 147-152) These bioidential hormones are consistent with our normal biochemistry. Our bodies were designed to recognize and utilize them. Prempro, on the other hand, isn’t normally found in the human female body so the metabolic breakdown of the products is biologically stronger and more active than products of bioidentical estrogens. These breakdown products from synthetic hormones can produce DNA damage that is carcinogenic in tissue. The metabolic breakdown products of bioidentical estrogens are biologically weaker, so their effects on tissue do not last as long (Northrup, 2001:139)

There is a full range of bioidentical hormones available by prescription from formulary pharmacies. The dosages can be and should be individually adjusted. A salivary hormone test measures the free hormone present in the saliva, which has been shown to be comparable to what is present in other body tissues. A test kit is sent home with printed instructions. Saliva is collected and placed into provided containers at one or more specific times of the day then sent to the laboratory. This will test for estrogen, progesterone, and testosterone levels. Then a formulary pharmacy will create an individualized lotion, cream, or other base to apply to the skin. (See Resources for formulary pharmacies: Northrup, 2001: 545)

Estrogen

There are three distinct estrogenic compounds produced naturally in the body: estriol, estrone, and estradiol, Estriol reaches it’s highest level during pregnancy. It has weaker biological effects on breast and uterine tissue than do estrone and estradiol. Supplemental estriol is known to be particularly effective in urogenital symptoms. It can be applied locally in the vagina and relieve urinary and vaginal conditions associated with the thinning of these tissues.

Estrone becomes the predominant estrogen after menopause. It is thought that estrone has an ability to protect heart and brain function and bone strength. It comes from women’s fat cells and does not appear to have a high cancer risk (Northrup, 2001:142-171).

Estradiol is made in the ovaries and prior to menopause plays a major role in stimulating growth in the breasts, ovaries, and uterus. It is interesting to note that after menopause the ovaries can continue to produce small amounts of estradiol, as do the secondary hormone-producing sites, such as the adrenal gland and fat cells. As a result, it is biologically possible for a woman to produce enough of her own estrogen to support optimal health throughout the second half of her life (Northrup, 2001: 154) Estradiol is more likely to be breast cancer inducing. But given in the bioidentical form it is weaker. Estradiol is the most common form of estrogen given in hormone replacement. Although some health providers believe a combination of all three estrogens should be given, other doctors believe that if women can get good results from Estradiol then why give addition estrogen.

Progesterone

The decline in progesterone is the first hormonal change to cause symptoms in a women approaching menopause. Progesterone comes primarily from the ovaries before and after menopause, but it is also made both in the brain and the peripheral nerves. It seems to eliminate many menopausal symptoms. It has a relatively unique ability to be converted into other hormones as needed. (E.g. cortisone, testosterone and estrogen.). It can be metabolized into other hormones such as testosterone, and estrogen. Because of this it is thought that a woman can get relief from her symptoms during early perimenopause if she uses a natural progesterone cream. John R. Lee, M.D., the Northern California physician who pioneered the study of natural or bioidentical progesterone in women after menopause, recommends ¼ teaspoon a day of progesterone cream (Wright, 1997:65)

From recent studies we are aware that synthetic progesterone can increase the risk of breast cancer. But we don’t know the effect of bio-identical progesterone on breast cancer. Studies need to be done using both bioidentical estrogen and bioidentical progesterone. Pharmaceutical companies generally finance most drug research. However Bioidentical estrogen and progesterone cannot be patented so there has been a lack of interest to fund research on these hormones. On the other hand Pharmaceutical companies can patent the mode of transportation used to get the hormone into the body such as transdermal patches, vaginal rings and vaginal estrogen creams. So maybe drug companies will increase research on these bio-identical hormones (Wright, 1997: 44-45)


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