Today’s menopausal woman is fortunate to have several forms of hormone therapy available to reduce hot flashes, anxiety, insomnia, mood swings, weight gain, loss of libido, brain fog, heart palpitations, headaches, thinning hair, dry skin and eyes, increased facial hair, pain during intercourse and urinary dysfunction.
Many women are afraid to use hormones and sorting through the facts relating to hormone therapy is confusing. Over a decade ago, the findings of the Women’s Health Initiative (WHI) put a screeching halt on the use of pharmaceutical hormones when an increased risk of cardiovascular issues was noted in the study. Unfortunately, this forced many women to suffer with their menopausal symptoms and the long-term consequences of estrogen loss, such as osteoporosis, dementia and Alzheimer’s.
It has been well established that estrogens isolated from the urine of pregnant mares, (CEEs, such as Premarin) cause undesirable health effects in women,1,2,3 and the pharmaceutical industry now offers bio-identical estrogen products, but what about progesterone? It turns out that the form of progesterone utilized for hormone therapy is of utmost importance.
Progestins are a synthetic form of progesterone and are most commonly found in birth control pills, emergency contraception, Provera and Prempro. In studies where progestins and bio-identical micronized progesterone have been compared, the progestins have repeatedly been found to increase breast cell proliferation while bio-identical micronized progesterone has not.3,4,5
Bio-identical hormones are molecularly identical to the hormones of the human body. It is important to note that the subjects of the WHI study were using medroxyprogesterone acetate (a progestin), NOT a bio-identical hormone.
In the updated 2017 position statement, the North American Menopause Society (NAMS) stated that hormone therapy remains the most effective treatment for menopausal symptoms6. Current studies are not showing evidence of increased risk of breast cancer risk for the first 5 years of bio-identical hormone use. There is a slight increased risk of breast cancer for longer use (statistics vary with types of hormones utilized).7,8 One also has to understand the limits of research because it is extremely difficult to obtain definitive numbers due to the fact that it takes years for breast cancer tumors to develop and many factors including age, genetics, toxin exposure, body weight, and exercise affect tumor occurrence and growth rates.
Each woman has a unique need for the type and amount of hormones that will control symptoms. Using bio-identical hormones from a compounding pharmacy allows for individualized treatment according to dosage and forms used to deliver the hormones. Bio-identical hormones can be delivered via capsules, creams, sublingual troches and injectable pellets. It should be noted that once implanted, injectable pellets cannot be removed and take 3 or more months to dissolve, making it difficult to mitigate side effects.
It’s important that you choose a doctor who will take the time to explain how to control your menopausal symptoms with hormone replacement, pharmaceutical drug, herbal and nutriceutical therapies, along with their benefits and risks, so you can decide what is best for your unique situation.
Please refer to our blog at womenshealthandhealingcenter.com for references sited.
- Murkes D, Lalitkumar PG, Leifland et al. Percutaneous estradiol/oral micronized progesterone has less-adverse effects and different gene regulations than oral conjugated equine estrogens/medroxyprogesterone acetate in the breasts of healthy women in vivo. Gynecol Endocrinol. 2012 Oct;28 Suppl 2:12-5.
- Murkes D, Conner P, Leifland et al. Effects of percutaneous estradiol-oral progesterone versus oral conjugated equine estrogens-medroxyprogesterone acetate on breast cell proliferation and bcl-2 protein in healthy women. Fertil Steril. 2011 Mar 1;95(3): 1188-91.
- Chang KJ et al. Influences of percutaneous administration of estradiol and progesterone on human breast epithelial cell cycle in vivo. Fertil Steril. 1995; 63(4):785-91.
- Fournier A, Berrino F, Riboli E et al. Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohort. Int J Cancer. 2005; 114(3): 448-54.
- Campagnoli, C., Abbà, C., Ambroggio, S., & Peris, C. (2005). Pregnancy, progesterone and progestins in relation to breast cancer risk. J Steroid Biochem, 97(5), 441-450.
- Menopause: The Journal of The North American Menopause Society, 2017 by The North American Menopause Society, Vol. 24, No. 7, pp. 728-753, http://www.menopause.org/publications/professional-publications/position-statements-other-reports
- Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer. Collaborative Group on Hormonal Factors in Breast Cancer. Lancet. 1997 Oct 11;350(9084):1047-59.
- Fournier, Agnès, et al. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat. 2008 Jan; 107(1): 103–111.