Hormone Replacement Therapy
Why is there so much fear about Hormone replacement therapy?
Physicians often disapprove of hormone replacement therapy (HRT) based on findings from the 2002 and 2004 Women’s Health Initiative (WHI) study, which linked HRT, specifically the combination of equine estrogen and progestin, to an increased risk of breast cancer, stroke, heart disease, and blood clots.
What do we know about the faults of the WHI study?
The study used conjugated equine estrogen (CEE) and medroxyprogesterone (progestin), which is not the same as 17-beta estradiol and progesterone that occur naturally in women.
There was no increased risk of disease found in the estrogen only arm of the study, only the estrogen + medroxyprogesterone (a progestin) arm, showing it is progestin, not estrogen that is more of a risky intervention.
The negative WHI initial data was based on women with an average age of 63.5, and when they separated out women 52-59, the results were universally positive
Many studies have been completed since the WHI showing that if hormones are initiated within 10 years of menopause and progestins are avoided benefits are seen for almost all women taking the hormones.
What is the difference between the hormones used in the WHI and the bioidentical hormones?
Simply put, a lot! You could even say they are completely different molecules in many ways. If your doctor or friends say hormones are not safe, ask them what hormones they are referring to, because it is true that some are less safe then others.
Progesterone (bioidentical) vs. Progestins/medroxyprogesterone (synthetic and used in the WHI study)
- Progestins block all the beneficial affects of 17-beta Estradiol
- Real progesterone (bioidentical) increases BDNF, a brain protective substance, but progestins do not
- Progesterone is neuroprotective, but progestins are not
- Studies show estrogen + progesterone (bioidentical) are associated with a lower rate of breast cancer, while CEE + progestins (synthetic) are associated with a higher rate of breast cancer
17-beta estradiol (bioidentical) vs oral conjugated Equine estrogen (CEE) used in the WHI trials.
- Oral estrogen (CEE and others) increase CRP which increases inflammation
- 17-beta estradiol helps women maintain cognitive function and reduces the risk of cardiovascular disease.
- Studies show that women who start estrogen therapy within 10 years of menopause have less dementia and less heart disease (the leading cause of death for women)
- Oral estrogens (CEE and others) increases fibrinogen, leading to increased clot risk
What did the 18 year follow up data from the WHI tell us?
The cumulative follow-up of all women in the WHI stated, stated that after 18 years women who started therapy from age 50-59, had decrease in all cause mortality at 18 year follow up
It clarified that certain groups of women, such as those under 60 or those within ten years of menopause, actually have a more favorable risk-benefit profile then initially stated on the 2002 data.
What testing is recommended to monitor hormone therapy?
We prefer serum (blood) or DUTCH (dried urine) hormone metabolite testing to assess and monitor hormone therapy. DUTCH offers additional benefits in understanding breast cancer risk and hormone metabolism.
Where can I get more info?
If you want to learn more I recommend that you read the book Estrogen Matters by Dr. Avrum Bluming and Carol Tavris.
Here is a brief overview below:
Estrogen Matters: A Revolutionary Look at Hormone Therapy
Introduction “Estrogen Matters” by Dr. Avrum Bluming and Carol Tavris challenges conventional wisdom on hormone replacement therapy (HRT) for menopausal women. The book critically examines past studies that have shaped negative perceptions of estrogen therapy and argues for its significant health benefits.
The Misconceptions About Estrogen For decades, estrogen therapy was widely recommended to help women manage menopause symptoms and protect against chronic diseases. However, the 2002 Women’s Health Initiative (WHI) study suggested a link between HRT and an increased risk of breast cancer and heart disease, leading to widespread fear and reduced use of estrogen therapy.
Bluming and Tavris argue that the WHI study was flawed, misinterpreted, and led to unnecessary panic. They contend that subsequent research has debunked many of the risks originally attributed to estrogen therapy, showing instead that it provides numerous health benefits when properly administered.
The Benefits of Estrogen Therapy The authors emphasize the protective effects of estrogen against:
- Heart Disease: Studies indicate that estrogen therapy can reduce the risk of heart disease when started early in menopause.
- Osteoporosis: Estrogen plays a key role in maintaining bone density and preventing fractures.
- Cognitive Health: Some evidence suggests that HRT may lower the risk of Alzheimer’s disease and cognitive decline.
- Quality of Life: Estrogen alleviates common menopause symptoms such as hot flashes, night sweats, and mood swings, significantly improving daily well-being.
Reevaluating Breast Cancer Risk One of the most controversial aspects of the book is its stance on breast cancer. The authors argue that the link between estrogen therapy and breast cancer has been overstated and that, for many women, the benefits of HRT outweigh the risks. They stress the importance of individualized treatment and consulting with healthcare professionals.
Conclusion “Estrogen Matters” is a thought-provoking book that challenges outdated beliefs about hormone therapy. It encourages women and healthcare providers to reevaluate the benefits of estrogen therapy, using modern research and personalized approaches to make informed decisions. If you’re navigating menopause and considering HRT, this book provides a compelling case for why estrogen may be an essential part of long-term health and well-being.
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Ready to assess or support hormones? Please book in with Dr. Nina or Dr. Dawn for hormone assessment and herbal support, or book in with Kathy Tissington, NP for BHRT options