The Truth About Hormone Replacement Therapy for Menopause
Hormone Replacement Therapy for Menopause
Are you suffering the symptoms of perimenopause or menopause? Are you still labouring under the illusion that hormone replacement therapy is evil?
You're not alone!
Many women are suffering needlessly from the symptoms of perimenopause or menopause. Often these symptoms are so severe that they can affect a woman's:
- personal & professional relationships
- physical & mental health
- quality of life
I hope to encourage new understanding of the facts while at the same time, negating the over-popularized myths.
Hormone Replacement Therapy: (HRT), is used to help the symptoms of perimenopause & menopause & involves taking the hormones, estrogen & progesterone. (Also called Menopausal Hormone Therapy - MHT)
How many years have you been suffering from the symptoms of menopause?
Women's Health Initiative Study
The foremost cause of death &/or impaired quality of life in postmenopausal women is:
- Cardiovascular disease
It was once widely believed that estrogen deficiency in postmenopausal women were part of the cause. The logical thought was that along with lifestyle & nutritional changes, drug intervention may prolong health.
Of course, any drug intervention requires clinical trials to set up the structure for public health policies & prevention guidelines. Enter, Women's Health Initiative Study!
The 15 year, Women's Health Initiative Study was massive! More than 160,000 post menopausal women from 50 - 79 years old were enrolled.
The first findings from the Women's Health Initiative Study were published back in 2002. Initially, they said that HRT increased the risk of both breast cancer & heart disease. Immediately, doctors started pulling their patients off HRT. Almost 50%!
Today things have changed.
In a final comprehensive report published in 2013 it was realized that age should have been taken more into consideration. Meaning that for younger, healthy women, hormone replacement therapy may not be such an ominous prescription.
There's such an irony to the saga of hormone replacement therapy. The pendulum has swung so widely, from "hormone therapy is good for all women" to "it's bad for all women" to now somewhere in between.— Dr. JoAnn Manson - Lead investigator of the Women's Health Initiative
Lagging Evolution: Olivia's Story (51)
It's occurred to me that HRT isn't really a drug. It’s more as though I’m replacing something (hormones) that are supposed to be at a certain level in my body so that the ongoing chemical reactions that sustain life can continue normally. Like vitamins. Except we can get vitamins from food. That precious estrogen & progesterone, you cannot.
Two hundred years ago lives were shorter. A 40 year-old female was already an elderly woman & menopause wasn’t the problem it is today. Due to medical science, we’ve started to live longer & longer lives.
The evolution of the human body has not kept up with our rapid advance in longevity. Hence the need to maintain a low level of estrogen because it has important jobs within the body & the progesterone to keep the estrogen in check.
It's not about taking enough hormones to remain fertile. It's about replenishing a low level of estrogen (accompanied by progesterone) that's naturally supposed to be in our bodies to keep both our physical & mental selves strong & healthy.
That’s my opinion & I’m sticking to it!
The Flaws in The Studies
- Women's Health Initiative Study (WHI) from 1993 - 2002 studied the effects of HRT on over 16,600 U.S. women.
- The Million Women Study (MWS) from 1996 - 2001 studied the effects of HRT on one million U.K. women.
* Note: All studies are flawed in one way or another mostly because "total control" is impossible. Having said that, studies are very important as they give a baseline & simply, they are a place to start.
Both the WHI & MWS included the following shortcomings:
- WHI studied only one dose & type of combined HRT - conjugated equine estrogens (Premarin) & medroxyprogesterone (Provera) or estrogen-only HRT.
- Both studies included mostly women who were older than 60 & already 10 years postmenopausal.
- At this age they were already at an increased risk for stroke, heart disease & breast cancer.
- The majority of women were already overweight.
- No allowances were made for diet, exercise, alcohol consumption or smoking.
- The MWS study was not a randomised controlled trial, where two groups of women are recruited and half given HRT and half a placebo.
"We have had time and resources to carefully tease out the data and perhaps collect a little bit more, and what we have found at least reassures us that for some women who have menopausal symptoms, HRT is not the ominous prescription we thought when the data first came out."— Cynthia Stuenkel, MD, Professor of Medicine at the University of California at San Diego
Natural Hormones Versus Synthetic Hormones
When a woman experiences those first symptoms of hormone decline & acts to alleviate them, she is initially confronted with consumerism. Namely, bio-identical or “natural” hormone replacement therapy & the actress-turned-entrepreneur, Suzanne Somers.
Just one glance at Suzanne Somers’s product laden website & a quick read through her Wikipedia biography should be enough to steer you toward more medically relevant information.
Nat·u·ral adjective \ˈna-chə-rəl, ˈnach-rəl\
- existing in nature and not made or caused by people : coming from nature
- not having any extra substances or chemicals added : not containing anything artificial— Merriam-Webster Dictionary
The Pharmacist Agrees: Samantha's Story (52)
Following is a discussion I had with my pharmacist:
“So,” I said to the pharmacist. “In your professional opinion, will these little pills kill me? You know, heart attack, stroke, cancer & so on.”
“No,” He said, smiling.
“Well,” I said, “Plenty of people are freaking out when I tell them that I’m taking this. Is your answer based on the Women’s Health Initiative Study?”
“Yes,” He said. “There were women who fell to these diseases but they already had issues in these same areas, so it doesn’t prove anything.
"Besides, the amount of estrogen in your prescription is so small & you’re taking the progesterone to counter any affects. What’s more, women have been on birth control pills for years without detriment.”
I smiled because that’s exactly what I thought & I handed him my credit card.
"What we discovered is that if a woman is between the ages of 50 and 55 when she starts taking hormones, or if she begins HRT less than 10 years after she started menopause, she has less heart disease and less death from any cause, compared to the placebo group,"— Steven Goldstein, MD, professor of medicine at NYU Medical Center & the N. A. Menopause Society
Compounding Pharmacies Versus Pharmaceutical Companies: The Five Facts
Many women are erroneously led to believe that bio-identical means:
- Compounded hormones sold through compounding pharmacies.
- More "natural” as they are derived from plants & customized to the patient.
- Safer than the FDA approved estrogen & progesterone produced & distributed by pharmaceutical companies.
Fact #1: Any hormone, whether from a compounding pharmacy or a pharmaceutical company, requires chemical processing to synthesize it into a usable product: a cream, a spray, a patch or a pill.
Fact #2: Both the terms bio-identical & natural are unregulated, open to interpretation & can be used in the way that the promoter believes will manipulate the most purchases.
Fact #3: Manufacturers extract estrogen from plants & synthesize it in to estradiol molecules. The identical estradiol molecules are sold to both the compounding pharmacies & the pharmaceutical companies.
Fact #5: Pharmaceutical companies must legally back up their claims, perform drug approval testing & quality assurance. They are also required to report all findings, negative & positive & list all possible side effects & safety risks.
The above five facts are summarized from the amazing article, Buyer Beware: "Bioidentical" Hormone Myths. by Doctor Lauren Streicher.
- Gynecologic Specialist, Assistant Clinical Professor of Obstetrics & Gynecology at Northwestern University’s - The Feinberg School of Medicine
Playing With The Dosage: Jessica's Story (46)
At first I just took the recommended dose every day:
- Estrace / Estradiol 0.5MG
- Promentrium / Progesterone 100MG
I swear I reversed aged about seven years! I felt fantastic!!! But after a few months, I began to experience extreme breast tenderness. Apparently this indicates excess of estrogen or lowered progesterone causing estrogen dominance.
Obviously this makes sense. With my ovaries spitting & sputtering, my hormones fluctuate on a day-to-day basis! This is when I realized that feeding my body hormones indiscriminately, regardless of my symptoms, had to be dangerous!
A close friend told me that her doctor had prescribed progesterone only & that this was the safest route. I found this unusual because progesterone & estrogen are hormones that keep each other in check. Isn't it illogical to take one without the other?
So I decided to take the progesterone everyday & only take the estrogen when the symptoms started coming back. Bad idea! An increase in progesterone makes you unbelievably hungry. I was ravenous! I started gaining weight!
I changed my tactic again.
When the symptoms started (usually hot flashes in bed) I would take one estrogen pill & one progesterone pill. In this manner, I could go weeks without taking my pills & then perhaps, I’d have to take them three days in a row. I still found it difficult to maintain my weight.
Then my doctor told me that it is safe to take 4 estrogen pills to one progesterone pill.
These days I take one progesterone pill for every third estrogen when I start to feel the symptoms. Right now this is the best way to ensure my hormones stay regulated (no symptoms).
Monitoring my symptoms & adjusting my dosage works really well for me. My doctor agrees. Plus it saves money.
Bio-identical Hormone Replacement Therapy
Are you still thinking along the lines of Premarin & Provera? That’s old news!
The good news is that pharmaceutical companies sell an assortment of bio-identical hormone replacement therapies that are fully FDA approved. You can obtain the prescription from your doctor.
What Are Bio-identical Hormones? is an article, published by Harvard Medical School, that includes an indispensable list of:
- All the brand names of estrogen & progesterone replacement therapies
- Their form (pill, patch, cream, etc.)
- Whether or not they are bio-identical.
There’s been much hoopla about salivary hormone testing being more accurate than the traditional doctor prescribed blood test. The purpose being to enable the compounding pharmacist to customize the hormone level to the individual.
However, this doesn’t take into account that woman’s hormones fluctuate daily during the (possible ten year) perimenopausal stage. Accurately testing levels of estrogen & progesterone today will do nothing to help the patient tomorrow.
So, is saliva testing more accurate? The jury is out. If you deem it important, it's easy to purchase the tests over the internet. You could even test every day! But that could get rather expensive.
The conventional blood test prescribed by your doctor is a necessity in the beginning to ensure that your symptoms are indeed stemming from decreased hormone levels & not from other causes such as disease.
- Post-menopausal Estrogen (Estradiol) levels are considered: < 120 pmol/L
- Post-menopausal Progesterone levels are considered: < 2 nmol/L
What's Your Opinion?
What is your choice regarding hormone replacement therapy (HRT)?
Choose a Healthy Lifestyle
Regardless of whether or not you choose to take HRT, paramount is the decision to choose a healthy lifestyle including:
- Eat only real food - starting with breakfast each morning.
- Drink lots of water.
- No smoking & consume alcoholic beverages in moderation.
- Participate in fitness including cardiovascular exercise, weight-training & stretching.
- Sleep 7 - 9 hours a night.
- Re-organize your life & relationships to reduce stress & increase happiness.
All Therapies Must Cater to the Risk/Benefit Ratio.
The regulated health care professional will always cater to the risk/benefit ratio.
- The benefit must be higher than the risk.
Women experiencing deterioration in their quality of life due to the symptoms of their estrogen/progesterone decline can confidently ease their suffering through "bio-identical" hormone replacement therapy as prescribed by their physician & as distributed by a pharmaceutical company. Under the conditions that the hormones are taken:
- To alleviate the symptoms of menopause (it does play a role in the prevention of osteoporisis but long term use is required).
- For only as long as necessary at the lowest effective dose.
- Under the yearly assessment of a physician.
This Information Does Not Replace Your Doctor's Advice
The decision whether or not to use HRT must be made by each woman accompanied by her physician on an individual basis. Lifestyle, medical history & the medical history of family members are strong factors & must be taken into consideration.
This "living article" is updated & refreshed on a consistent basis. If you would like to help other women by sharing your story here, please email me at: firstname.lastname@example.org.
Not only will your identity will remain private, you'll be able to choose your own pseudonym.
All rights reserved; no part of this publication may be reproduced or transmitted by any means, electronic, mechanical, photocopying or otherwise, without prior permission. Copyright 2014 - 2015.
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- Sylvia Leong RMT CPT ARS
- LEONG Orthopaedic Health
Tackling health & lifestyle concerns with the written word.
- Sylvia’s Profile & Article List
- Avrum Z. Bluming, MD, & Carol Tavris, PhD. (2009) Hormone Replacement Therapy: Real Concerns and False Alarms. http://www.breastcancerchoices.org/
- Nancy Shute (interviewing Dr. JoAnn Manson). (2013) The Last Word On Hormone Therapy From the Women's Health Initiative. http://www.npr.org/
- Lauren Streicher, MD. (2011) Buyer Beware: "Bioidentical" Hormone Myths. http://www.doctoroz.com/
- Harvard Women’s Health Watch. (2006) What are bioidentical hormones? http://www.health.harvard.edu/
Medical Websites Used For Research
- nia.nih.gov (National Institute on Aging)
- nhlbi.nih.gov (National Heart, Lung and Blood Institute)
Also the textbook "Principles of Anatomy and Physiology"
- by Tortora & Grabowski
© 2014 Sylvia Leong