Indications from recent studies and understanding the limitations of older studies…
Over a decade ago the interpretation of the Women’s Health Initiative (WHI) study virtually halted the use of hormones to relieve menopausal symptoms. What is important to understand is that Premarin, a conjugated equine estrogen (CEE) (made from horse urine), and synthetic progestin (called medroxyprogesterone acetate (MPA)) were the hormones implicated in the increased risk of breast cancer. These hormones are found in the prescriptions called Cenestin, Cenestin, Estratest, Menest, Premarin , PremPro, and Provera.
The media lavishly reported on the increased risks for breast cancer for women using hormone replacement therapy (HRT), but they and many others misinterpreted the results from the WHI study. The fact is, the supposed increased risk of breast cancer in the WHI study did not reach statistical significance – in other words, in the world of science and statistics, the increased risk was not considered relevant. In addition, because we have more effective methods for identifying different types of hormones, it is now known that CEEs contain many types of estrogens that are completely foreign to the human body. Well-educated and informed doctors are not prescribing this form of estrogen today.
We now have a lot more research using different hormones, called bio-identical hormones, which have the same molecular structure as the hormones we make in our own bodies. Bio-identical hormones are derived from natural sources, such as, soybean, yam, or other plants, and are designed to appear identical to human hormones.
Bio-identical hormones use estradiol (E2), estriol (E3), micronized progesterone and sometimes androgens such as DHEA or testosterone to provide symptomatic relief of peri-menopause, menopause and andropause. The bio-identical hormones are thought to be safer on the body, but it is still too early to have definitive research stating that this form of treatment cannot increase risk for breast cancer or heart disease. This is due in part to time. It take years for breast cancer tumors to develop and studies have shown that many factors, including age, affect tumor growth rates. In addition, there are different types of breast cancer that occur for different reasons. Finally, well-controlled studies are expensive and difficult because each woman is unique in the amount of hormones she produces, how she utilizes them, her past hormone use, her genetics, her lifestyle, and her health and wellbeing in general.
Why bio-identical hormones are recommended…
Studies have indicated that there is no increased risk of breast cancer in women who use bio-identical estrogen/progesterone therapy (EPT) for 3-5 years and a slight increased risk for those who use EPT longer. Women who do not have a uterus and who only use estrogen therapy, do not have an increased of risk of breast cancer. However, estrogens therapy is correlated with an increased risk of endometrial cancer, so progesterone must be given to offset the effect of estrogen on the uterine tissue. Clinical studies have shown that progestins (medroxyprogesterone acetate (MPA)) increase the risk of breast cancer. Therefore, it is imperative to use bio-identical progesterone if you choose to use hormone therapy for menopausal symptoms.
We know that oral micronized progesterone (OMP) (a.k.a. bio-identical progesterone):
- Does not increase proliferation in the breast tissue (demonstrated by two studies). Medroxyprogesterone acetate (MPA) – (Prempro in the WHI studies) does increase proliferation of breast tissue.
- Inhibits the proliferative effect of estradiol in human breast tissue.
- Provides symptom relief for insomnia and vasomotor symptoms (hot flushes and night sweats) when given with estrogen.
- Has less side effects.
- Has less cardiovascular adverse effects because it does not increase blood lipids and has a positive effects on the lining of the blood vessels.
- Is bio-identical metabolically.
- Has customized dosing so doses can be titrated (gradually adjusting the dose of a medication until optimal results are reached)
What to do for the premenopausal and menopausal and postmenopausal blues…
Bio-identical estrogen is the main hormone prescribed to relieve menopausal symptoms, such as hot flashes, brain fog, vaginal dryness and tissue breakdown, painful intercourse, and various urinary disorders. For women who still have their uterus, progesterone is prescribed to decrease the risk of endometrial cancer. Androgens are hormones that include DHEA and testosterone. These are normally produced in a young healthy woman, and are important for libido as well as integrity of skin, bone, and muscle. As women enter menopause, testosterone and DHEA levels may decline and may need to be supplemented.
For some women, it is not recommended to take estradiol in the pill forms that must be swallowed because it can induce the liver to make more blood-clotting factors, which increase the risk of stroke. Taking oral estradiol can also disrupt blood sugar and triglycerides. There are forms of estrogen, such as sublingual (under the tongue) troches (tro’-keez) or “melt” products, which pass directly into the blood stream through the thin membranes of the mouth, bypassing the liver. Other methods for estrogen replacement therapy are estradiol patches, gels, lotions, and topical sprays. There are also estradiol products for vaginal insertion that target the vaginal tissues directly, without exposing the rest of your body to the hormones in the products (an exception is the brand-name vaginal ring called Femring, which does deliver a systemic dose of estradiol).
If you have a uterus and are on estradiol estrogen replacement, you must also take a prescription-strength dose of oral progesterone to counteract the estrogen and protect your uterus. At the Women’s Health and Healing Center, we highly recommend oral micronized progesterone for the reasons listed above. For many women, bio-identical progesterone has a mood-stabilizing, calming affect; so many women prefer to take it at night.
How to get bio-identical hormones…
At the Women’s Health and Healing Center, a thorough intake will be done and labs will be performed in order to determine how you are metabolizing your hormones. Dr. Hamilton will recommend bio-identical hormones that are custom compounded to match each patient’s unique needs and body chemistry, instead of the “one size fits all” approach of pharmaceutical hormones. Compounding pharmacies can be very competitive with insurance copays. If needed, there are many forms of bio-identical hormones made by pharmaceutical companies that are FDA-approved, brand-name hormone preparations and available by prescription. Please remember that only compounding pharmacies can adjust amount of hormones in the preparations to provide customized hormone therapy in the most appropriate strength and dosage form to meet each woman’s specific needs.
If you are still uncomfortable about using hormone therapy to treat your menopausal symptoms, there are many options, including amino acids, bioflavonoids, herbal medicines, homeopathic remedies, nutrients, and diet and nutrition. Many of these treatments can enhance the effect of bio-identical hormones so a lower dose can be taken. Dr. Hamilton will take the time to explain the effectiveness, benefits and risks of the therapies to you so you can choose what is best for you.