1.
What lessons have we learned from the
Women's Health
It is abundantly clear that Premarin, Provera, and Prempro should not have
been the types of hormones used in that study, and all should be taken off the
market by the F.D.A. If those were drugs used by men, they would long
since have been removed. That does not, however, mean that hormone
replacement using non-oral human estradiol and progesterone is
included in the same negative results. Indeed, exactly the opposite is
true.
2. Should I stop hormone replacement
therapy?
If you are taking
Premarin, Provera, or Prempro, the drugs used in the Women’s Health Initiative
Study that has been so widely publicized in the last year, the answer is YES!
Does that mean you
should stop other hormone replacement regimes? NO! It means you should
switch to non-oral human estradiol and human progesterone in a cream, gel,
patch, or pellet form and monitor “free” estradiol and progesterone levels in
the blood to assure correct dosage.
3.
Will hormone replacement therapy increase my risk of breast cancer?
If there is any increased risk, it is minimal. Various studies show an increase
of zero to 5. Most authorities agree that estrogen speeds up the rate at which
breast cancer grows once it is there, but doesn't actually cause it in the first
place. This can work to your advantage, allowing you to discover the tumor
before it has a chance to metastasize (spread). Which explains why women who
discover breast cancer while taking hormones have a better prognosis than those
who develop it while not taking hormones.
By comparison, one half of a drink of alcohol per day increases your breast
cancer risk by 30%. Living in Marin County, California; Cape Cod, Massachusetts
or Long Island, New York raises your breast cancer risk by 70%.
Five studies now show a better prognosis for women who have had breast cancer
and continue to take estrogen. Family history of breast cancer is not a
deterrent to estrogen therapy.
4.
Will estrogen increase my risk of heart disease, stroke, or blood clots?
Herein lies the current controversy. The hallmark Harvard Nurses Study, which
has been ongoing since the early 1970s, shows a 61% decreased risk of
cardiovascular disease in hormone users. However the 2002 Women's Health
Initiative study shows a 29% increase. Why the huge discrepancy?
In
my view the discrepancy occurred because two-thirds of the women in the WHI
study did not start taking the estrogen until after age 60. Pre-menopausal women
nonsmokers rarely have fatal heart attacks. When estrogen (estradiol) production
by the ovaries ceases between ages 45 and 55 (menopause) heart attacks in women
(but not men) rise precipitously; equaling the rate in men by age 60 and
surpassing men by age 65. Once calcium plaques have occurred in coronary
arteries or elsewhere in the body, neither estrogen nor anything else will
reverse them ‑ the damage is done.
That is why it is important to start hormone replacement therapy as soon as your
blood levels begin to fall, usually during your early forties.
5.
Is the type of estrogen used important?
Definitely! Almost all studies in this country have been done using Premarin,
which is horse estrogen, and Provera, which is a synthetic progesterone. Neither
makes sense. Human bio‑identical estradiol and bio‑identical progesterone should
be used for humans.
6.
Is the method of administration important?
Yes! How you take hormones is just as important as the type of hormone you take.
Oral administration of hormones allows a "first pass" effect through the liver,
altering them completely and increasing the risk of abnormal blood clotting,
gallstones and high blood pressure.
Estrogen and progesterone should be administered non‑orally (not by mouth) in
the form of cream, gel, pellets or patches.
7.
What are other undisputed benefits of hormone replacement therapy?
Some of the benefits of HRT are…
65% decrease in colorectal cancer 70% protection against hip fractures
Prevention of vaginal atrophy, which causes decreased lubrication and painful
intercourse
Improved mental function including better memory, mood, cognition and sleep
Improved bladder function and less urinary leakage
8.
Should my estrogen blood level be monitored while I am administering
hormone replacement?
As
with any other hormone therapy, blood levels should be monitored. However it is
very important to have a correct test: A free-estradiol test is the one I
recommend.
Monitoring your
estrogen levels with a total estradiol (kit test) or by measuring
follicle-stimulating hormones in the blood. Both tests are totally inaccurate
and misleading.
9.
Does hormone replacement
therapy cause dementia or cognitive impairment in postmenopausal women?
This issue is another
example of media distortion. A recent article reported that these conditions
doubled with hormone use. The women in the study were using orally administered
hormones and started taking the hormones after age 65, much too late to prevent
cerebral arterial changes. Another study showed a 50% protection for women who
started taking hormones between ages 45 and 60, and continued for ten years.
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general informational or educational use only and is not intended to be used as medical
advice in specific situations. See your doctor regularly.
