Hormone Therapy: Controversies and Options
by Elaine Weil, Nurse Practitioner, Specializing in Women’s Health
A fundamental change has occurred in the approach of the medical profession towards menopause since the results of the Women’s Health Initiative Study were released. This was the largest study ever done on the effects of hormones on menopausal women. The combination arm of the study was stopped, midstream, when results showed that the use of the commonly prescribed combination of Premarin and Provera, did not provide protection against heart disease, and actually increased the risk of heart attacks, stroke and blood clots, along with an increased risk of breast cancer. Surprising as this was for many, we should take pause to realize that hormones have been marketed and used by millions of women since the 1960’s, and it is only now over 40 years later, that adequate studies have been done revealing the risks and benefits. So, now what do we do? Let’s take a closer look at this question.
The WHI study used only two hormone preparations, Premarin and Provera, which are not the same as the estrogens and progesterone made by our bodies. Premarin is a strong estrogen derived from the urine of pregnant mares, and has many chemicals not native to the human body. Some small studies have shown that Premarin tends to break down into toxic byproducts in the body. Provera is a synthetic progesterone. Some studies have shown that Provera may increase breast cancer risk. The WHI study really has told us “zip” about the safety of other types of hormone therapy. Women are rarely educated by their providers about the full range of hormone therapy options.
Menopause has been over-medicalized and overtreated. A natural and inevitable process is as normal as they come, not inherently something that needs medical treatment in and of itself. And yet many women experience uncomfortable, and for some debilitating symptoms during this time. Hormone therapy can offer significant relief. But the standard one-size-fits-all approach is sorely inadequate to meet women’s individual needs, risks and concerns. Giving common standard doses of hormones is akin to giving every diabetic patient the same dose of insulin! And yet standard hormone prescribing is the common practice.
The use of “natural”, “bio-identical”, or ”human-identical” hormones is an option that you should know about. These hormone preparations have the same chemical structure as the hormones made by the body itself, providing chemicals that the body identifies as its own. It is generally felt that these hormones should be safer to use with fewer side effects. Only a few studies have been done thus far on bioidentical hormones, the results of which have been promising. Their long-term safety has not been determined by large clinical studies, so we are still awaiting definitive research. I expect the results will eventually show a lower risk than the use of synthetic, standardized hormone doses. We have to realize that any drug, herb, or vitamin for that matter, carries potential risks that must be discussed and weighed against potential benefit.
If we look at the way hormones function in the body, we find that “Progesterone” helps to check cell growth and causes cells to become more differentiated, a property that would seem to deter cancerous growth. Of the estrogens made by the body, the weakest one, “Estriol”, often overlooked in estrogen therapy, can provide benefits such as relief of vaginal dryness, without the more potent stimulating effects of the stronger estrogens, “Estradiol” and “Estrone”. The stronger “Estradiol” may be needed for such symptoms as hot flashes if other approaches, such as herbal or vitamin supplements, fail to relieve, but can be given in very small dosages.
The key to using bioidentical hormones is individualizing the dosage, rather than the one-size-fits-all prescriptions generally given to women. Options include topical creams and gels, suppositories, patches, pills, sublingual tablets and drops. In this way, the minimum effective dose can be found, and fine adjustments made as needed. Hormone testing and monitoring can help guide the practitioner in adjusting to the lowest effective dose. Saliva testing is emerging as a non-invasive, accurate, and cost effective way of testing and monitoring hormone levels. Bioidentical hormones, individually prescribed and monitored, offer a good alternative to standardized, one-size-fits-all synthetic and animal-derived hormone prescriptions.
Tree of Life Medical Center 150 Catherine Lane, Ste I Grass Valley, CA 530-273-7400
