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Post-menopausal
HRT - an anti-aging physician's perspective
Dr
Craige Golding (specialist physician)
2007.06
A"Today's
truth is this: There is no magic hormone or combination
of hormones that can be indiscriminately used by all women.
Each women is an individual and hormonal balance must
be the ultimate goal for all women".
Joseph Collins, N.D
What
do we know about the synthetic hormone replacements?
The
government sponsored women's health initiative program
halted its study on estrogen plus progestin (synthetic
progesterone, prempro) on July 9 2002. This was three
years early because of an increased risk of breast cancer
in women taking these hormones. Analysis of the study
also revealed that heart attack risk began increasing
in the progestin group early in the study which was conducted
on 16000 women who had not had a hysterectomy. Participants
in the study were either given prempro or a placebo.
The study revealed the following results:
>>
The
stroke rate was 41% higher in women taking prempro
>>
women on prempro had double the rate of blood clots
>>
women on prempro had an increase of breast cancer of 26%
>>
women on prempro had a 22% risk in heart disease
>>
women on prempro had a 37% increase in colorectal cancer
>>
women on prempro had a decrease in fracture rate of the
hip of 33%
>>
women on prempro had a decrease in total fracture rate
of 24%
Additional
studies, such as heart and estrogen/progestin replacement
study (HERS II) agree with the findings of the women's
health initiative trial. Several other studies have shown
recently that progestins (synthetic progesterone) have
an unfavourable effect on lipid levels and may promote
cardiovascular disease.
Other problems with synthetic hormones include:
a) a lot of women (estimated at 1/2) stop taking their
hormones after 1 year due to being unable to tolerate
their side effects
b) incomplete messages are given to cells resulting in
wastage of energy and failing to produce a balanced hormonal
response
What do we know about natural hormone replenishment?
These
are some of the reasons you should consider natural hormone
replenishment/ replacement :
>>
relief of menopausal or hormone deficiency symptoms
>>
prevention of memory loss
>>
heart health (transdermal bioequivalent hormone replenishment
DOES NOT increase your cardiovascular risk at all
>>
bone production (prevention of osteoporosis)
>>
growth and repair
Natural hormone replacement means using hormones that
are biologically identical to what your body makes. Customised
natural hormone replacement is the safest way to replace
hormones. Hormone replacement shouldn't be considered
without a thorough understanding of how all your body's
hormones interact with each other.
Transdermal delivery of estrogen is far safer than oral
delivery for the following reasons:
Oral estrogen can:
>> Increase blood pressure
>> increase
triglycerides
>> increase
estrone
>> cause
gallstones
>>
can elevate liver enzymes
>>
can decrease growth hormone (the hormone that keeps you
youthful)
>> Interrupts
tryptophan metabolism and consequently serotonin metabolism
>>
increases sex hormone binding globulin (can decrease testosterone)
>>
increases carbohydrate cravings
>>
increases weight gain
Also:
>>
estrogen has more than 400 crucial functions in your body,
you need estrogen for optimal health
>>
The amount of estrogen you have is important, too little
or too much can cause symptoms
>>
Synthetic estrogen is not the same chemical structure
of estrogen that your own body makes
>>
Synthetic estrogen takes longer to be eliminated from
your body
>>
Synthetic estrogens have coatings and additives which
may cause problems
Mentioned earlier was the cardiac risk associated with
progestins. The following effects are seen with natural
progesterone, not seen with progestins:
>>
helps balance estrogen
>>
leaves your body quickly
>>
helps you sleep
>>
natural calming effect
>>
lowers high blood pressure
>>
helps your body use and eliminate fats
>>
lowers cholesterol
>>
may protect against breast cancer
>>
incresaes scalp hair
>>
normalizes libido
>>
helps balance fluis in the cells
>>
increases the beneficial effects of estrogens on blood
vessel dilation in atherosclerotic plaques
>>
has an anti-proliferative effect (decreases the rate of
cancer) on all progesterone receptors
>>
does not change the good effect estrogen has on blood
flow
>>
increases metabolic rate
>>
natural diuretic
>>
natural antidepressant
It is clear that natural progesterone offers a safer approach
to HRT than progestins.
Do you need progesterone if you have had a complete hysterectomy?
The answer is simply yes, since progesterone has many
positive ffects on your body listed above.
Are there cancer issues with hrt? (from
Brent Murphy)
Non bio-identical progesterone and non-bio-identical estrogen
increase the risk of endometrial and breast cancer
References
>>
International agency for research on cancer
>>
J.E Rossouw "Risks and benefits of estrogen plus
progestin in healthy postmenopausal women"
>>
G L Anderson "effects of conjugated estrogen..."
>>
C. Straczec et al "prothrombotic mutations
This is in contrast to bio-identical progesterone and
bio-identical estrogen which are considered protective
against breast cancer:
>>
bio-identical
progesterone protective (Campagnoli C. Pregnancy, progesterone
and progestins
>>
estriol(e3)
binding to the second estrogen receptor ER beta which
is a tumor suppressing receptor (Barden A, Boulle N, Lazannec
; loss of ER beta expression as a common step in estrogen
dependent tumor progression
>>
A leading estriol researcher Henry Lemmon postulates:
>>
in vitro when estriol is given with estradiol, estriol
accelarates removal of estradiol bound to protein receptors
>>
very little carcinogenesis initiated with estriol in animal
studies
>>
animal
studies confirm that estriol helps to prevent carcinogen-induced
mammary tumors
>>
estriol metabolism does not result in carcinogenis substance
Due to the possible protective effects of estriol, a combination
cream such as bi-est (estradiol and estriol) or tri-est
(estrone and estradiol and estriol) together with natural
progesterone replenishment seems to be the safest way
to replenish sex-hormonal deficiencies.
Afterall, the hippocratic oath that all doctors sign states
"first do no harm".
There is no evidence that transdermal bio-equivalent hormone
replenishment does any harm whatsoever.
Is there evidence that oral hrt can be dangerous if used
after the initial period when oral hrt
is mostly used to releave symptoms? yes
It seems also from subgroup analysis of WHI that initially
in the first few years of taking oral estrogen synthetics,
that there is an improvement in cardiovascular risk (a
decrease in coronary calcium score). However the longer
you use the oral synthetics the more likely your cardiovascular
risk might increase for reasons stated previously.
Some other thoughts...
"The problem with popular thinking is that it doesn't
require you to think at all." Kevin Myers
"It is easier to do what people do and hope
they thought it out" John Maxwell
"until we can get used to living with something that
is not comfortable we cannot get any better"
John Maxwell
"Courage is the power to let go of the familiar"
John
Maxwell
"The difficulty lies not so much in developing new
ideas as in escaping the old ones" John
Maxwell
"even when we know the changes are going to be better
for us and our patients we don't make them because we
feel uncomfortable or awkward" John Maxwell
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