There are probably few healthcare topics that are so polarizing and generate such heated debate as the subject of hormone therapy. Hormone replacement therapy in the post-menopausal woman can be a God-send, but is it really safe? Menopause has been referred to as a condition of “living decay”, and one New York gynecologist, Dr. Robert Wilson author of the 1966 book Feminine Forever, advocated the use of estrogen to save women form “the tragedy of menopause”. I would personally agree that life-altering hot flashes emanating from a human flame thrower, mood swings, weight gain, and my personal favorite, the dried up vagina that has left the building, complemented by the disappearing libido, are tragedies of monumental proportion! It’s interesting to me though that there is such division amongst healthcare professionals on this topic, yet such extremes still exist in treatment. I talk to women every day in my practice who express concern about using hormones because of what they’ve read/ heard, or they have been told by other providers that under no circumstances will they be prescribed any hormone therapy because it causes cancer. On the opposite end of the spectrum, I might encounter a much older woman still on the highest dose of Premarin, the synthetic equine estrogen. This lack of balance in treatment is certainly tragic, and disrespectful to the woman having out-of-body menopausal symptoms.
The most well-known study regarding hormone therapy was the Women’s Health Initiative (WHI) of 2002 which reported on the effects of animal-derived, synthetic estrogen and progestin. The conclusions were that the hormone treatment increased the risk of heart disease, stroke, blood clots, and breast cancer, and that the risks of HRT outweighed the benefits. There are other researchers and professionals within the medical community who disagree with the conclusions of the WHI. They assert that there were problems with the study in that the researchers used the wrong estrogen (Premarin is not a human hormone), they used the wrong progesterone (Provera is not a human hormone and actually blocks progesterone receptors), they used the wrong route of administration (oral estrogens INCREASE inflammation), and they used the wrong women, post-menopausal women age 50-79. Though I have searched extensively, I cannot find any further description of the study population, but one would have to assume many of them had co-morbidities such as obesity, prediabetes, diabetes, high blood pressure, etc. that would impact their outcome in the trial.
Although the WHI study was designed to evaluate the role of HRT in the prevention of diseases related to aging, many women and their providers also abandoned HRT as therapy for menopausal symptoms, and that is a shame. I am appalled that a provider will tell a woman that she cannot have hormones because they cause cancer, but will not tell their obese patient that she is at risk for cancer and other deadly diseases. Our political correctness and fear of offending is killing us AND our patients.
The other part of this conversation is to discuss the use of bio-identical hormone therapy (BHRT). These are derived from plant sources and are structurally identical to human hormones. As a consumer of bio-identical hormone replacement therapy, I am also concerned about safety. It is common to hear women declare that because they use natural hormones, they are not at risk for any untoward consequences, but this is simply not true. As wonderful as bio-identical hormones can be at relieving symptoms and improving quality of life, they are not “get out of jail free” cards. HRT is only a small piece of the total wellness puzzle. Determining the safety of any regimen is a complex process and is dependent on several factors. Several important points are as follows:
- Safety is dependent on what and how much is prescribed. BHRT is easily tailored to the individual based on history, symptoms, and hormone test results.
- The route of administration matters. Oral estrogen increases one of the toxic estrogen metabolites. Oral estradiol is associated with a marked increase in C-reactive protein, an inflammatory marker.
- The safety of ANY regimen is predicated on how the individual METABOLIZES estrogen. I feel that this is a significant factor in determining one’s risk from using any type of HRT. Certain genetic pathways influence the estrogen detoxification process and can be easily assessed and these pathways supported with lifestyle changes and the use of specific vitamins/nutrients. It’s interesting when I interview my patients, how often their stories tell of problems caused by estrogen dominance! These symptoms can include irregular, painful periods, PMS, polycystic ovaries, infertility, fibrocystic breasts, endometriosis, and uterine fibroids to name a few. Estrogen dominance in men will manifest as prostatic hypertrophy and prostate cancer. The very same pathways that wreak havoc prior to menopause, will continue to cause problems later if not identified and appropriately addressed. I use comprehensive urine testing for both male and female patients that not only shows the hormone levels and their relationship to each other, but the estrogen metabolites as well. The testing is affordable and provides rich detail on each person’s unique makeup and hormone metabolism.
- ANY hormone treatment should be a complement to an already healthy, anti-inflammatory lifestyle. Toxins, processed, franken-foods, sugar, obesity, blood sugar abnormalities, poor sleep, nutrient deficiencies, and stress ALL need to be addressed as part of an individualized wellness plan, decreasing risk of cancer and chronic disease, and giving YOU control over your long term health!