Hormone Replacement Therapy
Let’s put menopausal estrogen use in an historical perspective: Throughout history and as women have become over-nourished, the age of puberty has become younger. The age of menopause, however, has stayed the same, on average about 52. When the ancient Egyptians were going through menopause, the average age of death was ten years before menopause. Now the average age of death for women is 78 to 80. We live nearly half our lives past menopause. In the 1960s, scientists discovered hormone replacement and its benefits: improved cognition, less arthritis, stronger bones, better sleep, and better sex.
For decades now, millions of women entering menopause in America were prescribed Premarin or Prempro without much question. Premarin, a mixture of estrogens derived from the urine of a pregnant horse, and Prempro, a combination of horse estrogens and synthetic progesterone, served to replace female hormones that naturally dissipate in peri-menopausal and menopausal women, primarily estrogen and progesterone.
Healthcare providers and their female patients were shocked to learn that hormone replacement therapy was not as safe as they had once thought after receiving the data from the Women’s Health Initiative. The results of the study suggested that this type of hormone replacement therapy did not protect a woman from getting heart disease, and actually increased her risk of breast cancer, blood clotting and possible stroke. A reanalysis of this study was completed in 2007 further suggesting that actual heart disease risk factors was dependent upon what age a woman was when she began hormone replacement therapy. These results still remain controversial. Again, in 2008 the study underwent a reanalysis which concluded that hormone therapy is associated with an increased risk of stroke, regardless of when hormone replacement therapy is initiated.
There were major problems with the study. Sponsored by Wyeth, a major producer of HRT, the WHI looked at whether hormone replacement could prevent heart attacks, since estrogen is protective for heart disease. They set up the study as a placebo-control, double-blind study. The problem is, women who are on HRT know it, so they specifically chose women who weren’t having night sweats or hot flashes. The only women who fit that criterion had an average age of 63, more than 10 years passed menopause. By that age, permanent changes from estrogen deprivation, such as hardening of the arteries, have already occurred. Giving HRT at that point is too late to prevent it and can actually make it worse, so people had more heart attacks and strokes. If supplemention starts early in the mid-40s when menopausal symptoms first start, it has the potential to prevent heart disease. The recent increased concern about HRT is from following women in the original study who were on average ten-plus years beyond menopause, taking oral HRT for at least 15 years, in higher doses than are prescribed today, and taking a combination of estrogen and progestin. Even given that, the increase in breast cancer and death are very slight. None of the non-oral delivery systems or current age and dosage recommendations was studied.
Unfortunately many practitioners often label all hormone replacement therapy the same. What this means is that many women are often advised that the risks apply regardless of the type of hormones. The reality of the study and the reanalysis showed associated risks only for oral conjugated equine estrogens and synthetic progestins, not bio-identical hormones.
Bioidentical, non-oral estrogen supplementation is a different animal. Bioidentical hormones are made in the lab, and once they get into the body, your body recognizes them as their own. The only way that is likely to happen is via a non-oral route. Taking any estrogen orally requires processing in the liver before it goes to the rest of the body. That processing changes the oral medication into something else, a by-product not recognized as the youthful estrogen your body likes: estradiol. Transdermal creams bypass the liver.
Objectively, HRT is the best way to protect bones. Osteoporosis treatment is only second-best because while it increases the density of bones, it makes them very brittle. It’s a different architecture.
Meanwhile, women continue to come to us every day, completely confused and even scared about hormone replacement. We have always been dedicated to clearing up misconceptions about hormone replacement therapy, and . providing women with alternatives to conventional hormone replacement, including bio-identical hormones Because there haven’t been many definitive studies done on bioidentical hormone replacement therapy, we do not know exactly what the risks are for every woman taking it. What we do know is that from the results of studies that have looked at bio-identical hormone replacement therapy, and from what has been seen in the clinical practice of prescribing bio-identical hormone replacement to patients, bio-identical hormone replacement therapy does not appear to have the same side effects consistent with conventional hormone replacement therapy, in particular transdermal forms.
Bio-identical hormones have been shown to share the exact same molecular structure with those found in our bodies. Unlike conventional or synthetic forms of hormone replacement therapy, they are not patented and sold by pharmaceutical companies. That is the main reason why there have been very few studies to evaluate their risks and benefits. Bio-identical hormones are not as profitable as the conventional synthetic forms. In the future, more studies will be done to help clarify the benefits or disadvantages associated with bio-identical hormone replacement therapy.
There has have been serious efforts made to shut down compounded bio-identical hormone replacement therapy as an option for women. The belief of our office is that women deserve to know all of their options and alternatives surrounding hormone replacement therapy. They need to be fully informed of everything we have learned and have access to these options when they need them.
In order to find answers to your questions about bio-identical hormone replacement therapy and how to decide if that could be a better choice for you, please call our office at (314) 292-7080 to set up a consultation with one of practitioners. We here at Women’s Health Specialists of St. Louis are dedicated to your complete healthcare needs. Educating yourself as much as possible will always lead you to better health. Being informed is the only way you can decide the right decision for yourself.