The Dangers of Hormone Replacement
The recent media blitz on the negative effects of conventional hormone replacement therapy (cHRT) has, understandably, fostered reactions from bewilderment to outrage. With good reason, women should be alarmed that what they have been sold as the fountain of youth could instead be the kiss of death.
For decades, cHRT has successfully treated menopausal symptoms such as hot flashes, vaginal dryness, night sweats and insomnia. Although not life-threatening, these symptoms can be detrimental to health and quality of life. Several recent articles I've read, condemning cHRT, have entirely trivialized these problems. I suspect the authors to be men who may regret having called insomnia trivial when their prostates swell and nature calls, awakening them all through the night. Women have also started cHRT hoping to prevent the diseases of aging like heart disease, osteoporosis, Alzheimer's and even some forms of cancer.
More than 16,000 women were enrolled in an eight-year study to determine the risks and benefits of various forms of cHRT. One of the studies was terminated after only five years because of conclusive evidence that Prempro, a combination of an estrogen and a progestin, causes more harm than good. The study using an estrogen alone is still in progress.
In this study 30 out of 10,000 women who were given a placebo and 38 out of 10,000 who were taking Prempro developed invasive breast cancer. In other words, Prempro increased a womans chance of developing breast cancer by 27 percent. For every 10,000 women using Prempro, eight more had strokes, seven more had heart attacks, and 18 more had complications from blood clots than among those taking a placebo. This means strokes increased by 38 percent, cardiac complications (mostly nonfatal heart attacks) increased by 23 percent, and blood clots or thromboembolisms, particularly injurious to the lungs, brain and heart, increased by 52 percent.
Favorable findings of the study included six out of 10,000 fewer colon cancers and five out of 10,000 fewer hip fractures for those taking Prempro compared to placebo. In the final analysis, there were 30 more negative outcomes per 10,000 women from taking Prempro than from taking a placebo. These are not acceptable side effects or risks to achieve some greater good, especially considering many of the complications were what women tried to prevent by taking cHRT in the first place. When the cure increases ones chances of developing the disorder, something has gone tremendously awry.
Prempro is a combination of Premarin and Provera, the two most commonly prescribed and widely researched hormones used in cHRT. Premarin is extracted from pregnant mares urine, which is how it gets its name (pregnant mares urine). It is composed of equine estrogens, which are foreign to humans and problematic for us to metabolize. Because of this, Premarin often increases an undesirable form of estrogen known to be carcinogenic. It also contains some estrogens found in humans.
Provera, or medroxyprogesterone, is a synthetic version of progesterone; its actions bear little resemblance to the natural hormone. Most physicians mistakenly call Provera progesterone, so its not surprising that the media doesnt understand, let alone emphasize, the difference either. Comprehending the available information on cHRT requires an extensive understanding of hormone physiology. Unfortunately, very few physicians and even fewer in the media can explain cHRT or converse intelligently about the variety of viable and healthy alternatives to cHRT already in existence.
Even more disturbing are many of the "solutions" or alternatives to cHRT offered in popular magazines. No one has mentioned using the real ones to combat hormone deficiencies. Instead, recommendations include Prozac for depression, Lipitor for cholesterol, high blood pressure drugs to treat hot flashes and, of course, the recently patented (and profitable) designer estrogens and biphosphates to treat osteoporosis. The side effects of these are alarming.
Conventional medical doctors have known for decades that progesterone counters the negative effects that excessive estrogens can cause throughout a womans system. With consistent use of inappropriate hormones like Provera, however, this knowledge dwindled to the myth that progesterone only protects the uterus and is therefore unnecessary if a woman has had a hysterectomy. The entire foundation of cHRT has been faulty from the beginning because of misinformation like this.
Its not the least bit surprising that using mismatched and artificial hormones has delivered less than optimal results. What is surprising is that it has taken medicine this long to figure that out. Almost everyone intuitively understands that using diesel truck parts in a finely tuned sports car would hamper performance, if not stop it altogether. Yet, were repeatedly given the equivalent of diesel parts for our finely tuned human bodies.
Patent laws in this country favor the creation of synthetic artificial chemicals to the exclusion of anything natural. Since anything that occurs in nature cannot be patented, it will never be astronomically profitable. This simple fact has affected medical education and practice since its inception.
It is in the drug companys interest to convince medical doctors and the public that natural herbal remedies and bioidentical hormones are either useless or extremely dangerous and uncontrolled. Never mind hundreds, and in many cases thousands, of years of safe and effective herbal use by humans. As for the hormones, Ill put my money on three million years of human evolution over 50 years of questionable pharmaceutical research.
Estrogens refer to an entire class of hormones, some of which occur naturally and many of which do not. This critical distinction is often blurry to both modern medicine and the media as well. Estrogens promote secondary sexual development in women. Estrogens are more dominant in the first two weeks of a womans menstrual cycle and prepare her body to get pregnant. The prominent estrogens in women are estradiol, estrone and estriol. Estradiol is the most potent of these hormones and the one most likely to be prescribed after Premarin. Even estradiol has proven to be problematic because it has been prescribed in isolation or with Provera.
Neither of these regimens provides the proper hormonal balance. Progesterone is not the name of a class of steroid hormones like estrogen is, but is a single specific hormone. Progesterone promotes gestation, in other words it maintains a healthy pregnancy, and thus its name pro-gest-erone. Progesterones other beneficial effects include protecting against fibrocystic breasts, acting as a natural diuretic, helping burn fat for energy, protecting against endometrial and breast cancer, and protecting against and even reversing osteoporosis. Progesterone acts to both balance and enhance the effects of estrogen.
Labeling estrogens bad and progesterone good would be as ridiculous as labeling the brake in your car good and the gas pedal bad. One without the other would either be a disaster or a standstill. The balance between these two hormone classes is as important as their actual levels. This applies both to hormones generated internally and those acquired through replacement therapy.
Too much estrogen relative to progesterone creates a host of problems which include weight gain, PMS, endometriosis, uterine fibroids, breast tenderness, headaches, leg cramps, gallstones, high blood pressure, blood clots, nausea, fluid retention, and an increased risk of endometrial and breast cancer. Too much progesterone relative to estrogen causes it own set of problems, which include depression, fatigue, somnolence and breast tenderness as well.
An optimal ratio ranges from 35 to 75 times more progesterone than estradiol. Be careful when evaluating lab tests because many report the hormones in different units. Estrogens are often reported in picograms (pg) and progesterone is often reported in nanograms (ng). In order to normalize them progesterone must be multiplied by 1,000. Then just divide the number for progesterone by that for estradiol and you will have your ratio. For menstruating women, this ratio will fluctuate throughout her cycle.
Luckily, many options are available to women today besides choosing between inappropriate hormones or none at all. Bioidentical estrogens, progesterone and testosterone are available from compounding pharmacies. Bioidentical is the term that most accurately describes these hormones. Since they are synthesized in a lab from wild yam or soy they are not, technically, all natural. Unlike conjugated estrogens and Provera, however, which are also derived from soy or wild yam, bioidentical hormones are exact replicas of those found in humans. Premarin, on the other hand, is all natural but is far from bioidentical for women.
Women who feel hormone replacement therapy is still appropriate should seek out a practitioner knowledgeable and experienced in the use of bioidentical hormone replacement therapy (bHRT). For those women who would rather never use HRT in any form, or who want to discontinue the ones they are on, several other options exist. Herbs have been used safely and successfully for generations to ameliorate the problematic symptoms menopause can often trigger. Both Western and Chinese herbal traditions have numerous solutions for climacteric women.
Women whose diets have included a wide variety of legumes including soy, lots of vegetables (especially cruciferous ones like broccoli), and healthy fats like fish and flax seed oils, have often sailed smoothly through the change. This is especially true for many Asian women whose diets are especially rich in phytoestrogens. Phytoestrogens, the most well-known of which are the isoflavones from soy, are not technically estrogens or steroid hormones at all. They do, however, have an estrogenic influence within the human body. How safe these are is currently in question,s since some studies have found excessive amount of these may fare no better than the estrogens themselves.
Why some women seem to glide through menopause while others travel a rocky road would fill an entire article itself. Genetic variation is certainly one reason, but would not explain why your mother or grandmother may have had such a different experience. That we do not live in the pristine world of our ancestors but instead in a world saturated with toxins, many of which have potent and troublesome estrogenic activity, may better explain some differences. Women need to pay particularly close attention to the animal products they consume. Estrogens are often given to commercially raised chickens and cows to fatten them up so they weigh more when sold. Choose organic produce and free range animal products whenever possible.
Finally, the fact we start many women in their teens or early twenties on the kiddy version of Prempro, otherwise known as birth control pills, nearly ensures them a lifetime of hormonal problems. These pills are entirely artificial versions of both estrogen and progesterone, whose list of side effects parallel the problems found with cHRT.
With millions of women worldwide reconsidering their use of cHRT, it is essential they receive accurate, untainted and ultimately useful information on alternatives to cHRT. Remember the conclusions drawn using incompatible and artificial hormones do not automatically apply to the authentic ones. Bioidentical HRT is still a very viable option. Next month we will explore, in-depth, bHRT as well as nutritional and herbal remedies for menopause.
Menopause is neither a disease nor an event, but a process women go through as they cease to menstruate. Although all arrive at a common destination, the paths that get them there are as unique and numerous as the women traveling them. Each womans experience is likely to be influenced as much by her psyche and society as by her biology.
In cultures where the Goddess still resides in heaven, women are lovingly midwifed through menarche and menopause. If the prevailing cultural myth about women is a negative one, as ours is, the menopausal archetype of the wise and powerful crone deteriorates into a weak, withered and worthless old woman. Instead of something to celebrate, menopause becomes something to medicate. The negative impact of this perceptual shift on women stretches from the cradle to the grave.
As last months article discussed, many other inventions of our modern world are also detrimental to ones menopausal journey -- nutrient-deficient diets, hormone-laden animal products, environmental toxins like pesticides, and a long history of using synthetic hormones such as birth control pills. Our fast-paced, high-pressure lifestyle has been particularly injurious to menopausal women. All these factors have made finding viable solutions to menopausal symptoms much more urgent. Until recently, the only options readily available to women in this country were conventional hormone replacement therapy (cHRT) or nothing at all.
Conventional HRT has, however, been quite ineffectual. Besides being given the wrong hormones, all women were given the same amount. Imagine going into a department store looking for a comfortable pair of cotton pants and being told the only ones they had were a spandex polyester blend four sizes too small. You wouldnt think twice about walking out and shopping somewhere else. Yet for decades, women have been offered a one-size-fits-all synthetic blend as the only solution to extremely varied hormonal needs. Its a frightening idea for clothes and should be for HRT as well.
Fortunately, things are changing. Every aspect of menopause is being reexamined. Women are demanding options and theyre getting them. Some women have realized the only problem they have had during menopause is everyone pressuring them to take hormones. They feel fine and probably dont need them. Some are thriving by improving their diet and starting to exercise. Many more are exploring the world of herbs. Others have chosen to give bioidentical hormone replacement therapy (bHRT) a try.
Bioidentical HRT not only provides the correct hormones, but can also be individualized to provide only the hormones a woman needs in the doses that she needs them. Not every woman needs every hormone. Such specific formulations are created by compounding pharmacies, which also provide them in a variety of delivery forms. Hormones can be made into capsules, creams, lozenges, liquids and suppositories.
A thorough medical history helps determine what hormones may be needed. Information from laboratory tests more precisely determines ones hormonal needs.
If a woman is already on cHRT, testing wont be able to determine much. Most of the hormones used in cHRT arent the ones being tested for and they alter the values for the hormones that are. Hormonal adjustment can be made based on persistent or newly emergent symptoms. Additional laboratory testing after starting the hormones helps determine whether the hormone ranges and ratios are all optimal, or if the dosages need adjustment.
Although exhaustion of the ovaries heralds menopause, ones adrenal glands function is likely to determine ones experience. These small triangular glands sit atop the kidneys and share a close common ancestry with both the ovaries and the testicles. These glands make all the steroid hormones, and the differences lie in the quantity of these hormones produced.
The adrenal glands produce mostly cortisol, DHEA and small amounts of other hormones including testosterone, estrogens and progesterone. Once the ovaries retire, the adrenals are largely responsible for producing the hormones that remain in circulation. Although western medicine only acknowledges the most extreme cases of adrenal failure as a problem, adrenal exhaustion is epidemic.
The adrenals are our bodys shock absorbers. They are called into action to help us cope with stressful situations. If ones adrenals are overworked and exhausted, they may not make enough cortisol, DHEA, and other hormones. Caring for the adrenal glands is, therefore, essential for ensuring ones menopause go as smoothly as possible. It should be paramount for those who would rather not use any form of HRT.
Short-term stress does us little harm, but we are not meant to endure the chronic, unrelenting stress that so many experience today. When this happens, the adrenal glands go on overdrive, which eventually exhausts them altogether. Adrenal stressors include skipping meals, insufficient sleep, prolonged infection, trauma, chronic pain, stimulants like caffeine, and constant anger, fear, worry, or guilt.
Symptoms and signs of adrenal dysfunction include fatigue, nervousness, anxiety, unrefreshing sleep, frequent infections with prolonged recovery and hypoglycemia. A simple saliva test, requiring four samples collected throughout one day, can help evaluate how well the adrenals are actually functioning. Treatments can include using bioidentical cortisol and DHEA, vitamins, glandulars, acupuncture and, of course, herbs.
Herbs known as adaptogens can be particularly important in helping menopausal women respond to stressful situations. Adaptogens are unique in that they can calm an overactive adrenal system or rejuvenate and energize an underactive one. Adaptogens include the well-known herbs like panax ginseng, Siberian ginseng and astragalus. Ashwagandha is an ayurvedic herb with adaptogenic qualities; its reported to be less stimulating than the ginsengs. Licorice root is a specific for low adrenal function and contains substances very similar to some adrenal hormones. Herbs used to address the specific needs of menopausal women include dong guai, false unicorn root, sage and wild yam. Herbs which research has confirmed to have potent estrogenic influence include black cohosh, red clover and alfalfa.
Chinese herbology has a large repertoire of formulas to address both adrenal imbalances and most menopausal concerns. These will often include the kidney qi tonics and herbs to strengthen kidney yin or yang. Although the medias bold announcement of "HRT, the end of an era" has put some into mourning, many more celebrate it as an exciting development that may help usher in an era where womens bodies are their own, their voices are not silenced, their experiences are not discounted, their feelings are not repressed, and the transitions through which their bodies go are not treated as diseases. If youre one of the many women entering menopause, sit for a moment and ask yourself what feels right. When you get a sense of direction, seek out the best advice to get you where you want to go.
Todd Mangum, M.D., of the Web of Life Wellness Center, is a holistically oriented physician practicing in Salt Lake City. To reach him, see the Community Resource Directory, under"Physicians."