Hormone Replacement Therapy adverse effects, HRT - Alternatives,
natural herbs and Chinese herbal remedy
January 3 2019
Guidelines
Women who have gone through menopause are recommended to avoid using
female hormones to protect against osteoporosis or diabetes. The overall
benefits from taking hormones to prevent chronic conditions are
outweighed by the harms and side effects. This is for all types of
hormone replacement therapy, including pills or patches containing
either estrogen or an estrogen/progesterone mix. However, those going
through menopause can take short-term advantage of hormone replacement
therapy to reduces symptoms such as hot flashes and vaginal dryness.
The estrogen most commonly prescribed for women as
hormone replacement therapy HRT after menopause is Premarin derived from
the urine of pregnant mares (horses). The progesterone prescribed to
most women is synthetic progestin. A recent big drop in breast cancer
cases might be due to millions of women going off hormone replacement
therapy. Hormone use plummeted after a 2002 study found that it raised
the risk of breast cancer, heart disease and other problems. Using HRT
for several years increases
the risk of heart and vascular events and blood clots. It not only increases the risk of first-time breast
cancer, it also makes recurrence of the malignancy more likely.
Hormone therapy helps with menopause-related symptoms such as sleep
and memory problems only if a woman also has hot flashes, according to
North American Menopause Society, news release, Nov., 2013.
Adverse effects of HRT,
potential problems and concerns
Blood clot
J Thromb Haemost. 2014. The risk of recurrence in women with
venous thromboembolism while using estrogens: a prospective cohort
study. Women who had their first venous thromboembolism while using
estrogens have a low risk of recurrent VTE. These women might not
benefit from extended anticoagulant therapy.
Breast cancer
Women who take hormone replacement pills are more likely to die from breast cancer. Journal of the
American Medical Association, 2010.
Women who develop breast tenderness for the first time while on hormone replacement therapy may be at increased risk of invasive breast cancer. Arch Intern Med 2009.
Hair loss, thinning
Email - I am a 43 year old female. I started HRT (testosterone and progesterone)
the summer of 2014 for mild pre menopause systems. When I went for my follow up
my doctor increased my testosterone and gave me 5mg of DHEA supplement. 2 weeks
after starting the higher does of testosterone and the DHEA my hair started
falling out in clumps. I didn't make the association and took the DHEA for 36
days. It has been 5 weeks since I stopped everything and my hair is still
falling out at a crazy rate. Can you please let me know if my body is ruined
forever? I am so scared, I cry everyday. This has ruined my life!! I feel so
stupid and can't believe I did this myself.
A. In many cases after stopping the hormone treatment hair begins
to return, however each person is different and it is not easy to predict.
Heart attack risk
Dr. Kanaka Shetty from the RAND Corporation in Santa Monica, California has
found that as the use of HRT has fallen in recent years, so too has the
incidence of heart attacks in older women. In 2002, the Women's Health
Initiative found that HRT use increased the risk of heart attacks among healthy
postmenopausal women, leading to a sharp decline in its use. HRT usage rates
among women aged 50 to 69 years remained fairly steady in the mid-1990s and then
declined sharply in the 2000s, following the pivotal report on HRT, from over 30
percent of the population in 2001 to less than 15 percent in 2005. Rates of
heart attack declined steadily over this period with a sharper decline in the
post 2001 period, especially among women aged 50 to 59 years. Medical Care 2009.
Hormone replacement therapy (HRT) does not protect most postmenopausal women against heart disease and may even increase their risk of stroke.
Lung cancer
Women who have used hormone
replacement therapy combining estrogen and progestin have a higher risk of lung
cancer than non-users. Journal of Clinical Oncology, 2010.
Meningioma associated with
hormone replacement therapy
Multiple lines
of evidence link meningioma with female hormones, including expression of
estrogen and progesterone receptors and higher incidence in women and in
patients with breast cancer.
Ovarian cancer
Women who use HRT for only a few years are more likely to develop the
two most common types of ovarian cancer, compared to women who had never
taken HRT. Those types are serous epithelial and endometrioid ovarian
cancer. Short term HRT use, thus far, is not linked to an increased risk
of the other two main types of ovarian cancer: mucinous and clear cell
ovarian cancers.
HRT effect on physical decline
with age
Older women on hormone replacement therapy do not seem to gain any
protection from disability as they age. There has been speculation that
waning estrogen levels may contribute to
muscle loss and other declines
in physical function as women age. Muscle cells have receptors for
estrogen, and some research has linked higher blood levels of the
hormone to greater muscle strength in elderly women. However, a study
did not find HRT to be helpful in preventing physical decline in older
women. Menopause, February 2010.
Natural hormone replacement therapy
and treatment
This is achieved by using
natural bioidentical hormones. Another option is to use over the counter
hormones such as pregnenolone and DHEA. Still, some people may consider the use
of phytoestrogens in herbs or extracts such as isoflavones
as natural hormone replacement therapy.
Q. There is considerable information coming my way
about Natural Hormone Replacement Therapy, including Testosterone for women. Do
you recommend this? Is there over the counter supplements that would be worth
trying instead of compounding formulas from physicians and pharmacies?
A. The whole issue of hormone replacement therapy is very
complicated and there are no clear answers of which hormones and in what dosages
are helpful or harmful. Each woman is different. Some may benefit from
traditional estrogen / progesterone hormone replacement therapy, others may
benefit from natural hormone replacement therapy with bioidentical hormones,
still others may benefit from the use of natural herbs. It is also quite
possible that health is harmed by taking hormones, particularly for prolonged
periods.
In vitro estrogenic activities of Chinese medicinal plants traditionally
used for the management of menopausal symptoms.
J Ethnopharmacology. 2005.
The estrogenic activity of 32 traditional Chinese
medicinal plants, selected according to their reported efficacy for the
treatment of menopausal symptoms, was assessed. Polygonum cuspidatum had the
highest estrogenic relative potency followed by Rheumpalmatum, Cassia obtusifolia, Polygonum
multiflorum, Epimedium brevicornum, Psoralea
corylifolia, Cynomorium songaricum, Belamcanda
chinensis, Scutellaria baicalensis, Astragalus
membranaceus and Pueraria lobata - kudzu. This study gave support to the reported efficacy of Chinese medicines
used for hormone replacement therapy.
When to appropriately use HRT
Systemic HT is an most effective treatment for most menopausal symptoms,
including vasomotor symptoms and vaginal atrophy; however, individualization is
key. Progesterone therapy may be necessary to prevent endometrial cancer when
estrogen is used systemically in women with a uterus. Local estrogen therapy is
effective and preferred for women whose symptoms are limited to vaginal dryness
or discomfort with intercourse; low-dose vaginal estrogen therapy is recommended
in this setting.
Controversies
- response to the January 2009 newsletter
We had an unprecedented number of email responses to the
newsletter. Here is one example: "The January
2009 newsletter discusses the disastrous effects of conjugated equine
estrogens and synthetic progestins uncovered by the Women’s Health
Initiative study in terms of increasing breast cancer risk, but you seem
not to make a major distinction with natural bio-identical hormones. My understanding is that the WHI did not study the use of
bio-identical human estrogens and progesterone at all. Everything I’ve
read indicates that they have a completely different effect on women’s
bodies, and in fact progesterone (the real thing, not synthetic progestins) may be
protective against breast cancer. I think you should distinguish between
the two."
Over the past few decades doctors have prescribed horse-derived
estrogens and synthetic progestins to women in order to relieve menopausal
symptoms and as a way to potentially reduce the risk for osteoporosis or heart
disease. A few years ago doctors began suspecting that, in many or most women,
the harm from this treatment in terms of increased breast cancer risk and heart
disease outweighs the benefits. Many women stopped taking these medications,
others turned to herbs and supplements, and still others turned to natural
hormones such as bioidentical hormones. Many of you may not be familiar with
this term. Bioidentical hormones differ from traditional hormone replacement
therapy since they are chemically identical to hormones found within the body --
such as estradiol, estriol, and progesterone -- rather than molecules that are
similar, but not identical to human hormones (such as Premarin, derived from the
urine of pregnant horses) or synthetic progestins (such as medroxyprogesterone).
Many women believe that these bioidentical natural hormones are safe, or safer.
These bioidentical hormones are promoted by compounding pharmacists, some
alternative medicine practitioners and even one celebrity, Suzanne Somers.
Estradiol is also available in many FDA-approved pills, patches, creams and gels
from traditional pharmaceutical companies. Is there evidence to support the
safety or superiority of bioidentical hormones over standard hormone replacement
approaches? I will focus most of this newsletter on this issue.
Here are some of the emails we received and my responses.
Q. I think your information is great, but I
strongly disagree regarding estrogen / progestin. First of all, both
Premarin and progestins should be against the law, as we women are not
horses and synthetic progestins are carcinogenic. However, bioidentical
hormones are a different breed and I have been on them (low dose) for
the last 5 years. I don't even think about cancer. I eat a very strict,
clean, mostly organic diet and go to an MD who knows what he's doing.
Yes, Western medicine is the problem---still giving women Premarin and
progestins---it's a disgrace how mishandled most women are today at the
hands of misinformed and arrogant doctors who don't want to learn what's
new and better.
A. All doctors, including me, are fallible and have the potential
to make mistakes or give wrong advice. In the past few decades many doctors were
just as assured and
complacent of the safety of hormone replacement therapy with PremPro as
many bioidentical hormone promoters are today. There are currently no
long term studies with bioidentical hormones to prove their safety.
Q. Dear Dr. S, the horse urine estrogen and
synthetic progestin that have been fed to women world wide has been
the problem, not bioidentical estrogen and progesterone. The
scientific analysis of these products is very clear. Additionally, the
very large studies that recalculated their data did point out that the
addition of the synthetic progestin seemed to be a large factor in the
negative effects. I am 63, was never able to take the horse urine
product without feeling ill, so I didn't, even after my hysterectomy at
33 with the inevitable negative results for my bones. Five years ago, my doctor started me on a bio-identical
estrogen patch, along with additional magnesium and bio-identical
topical progesterone cream. My annual DEXA scans have shown an amazing
gain in bone strength, this includes both hip and spine. I
no longer expect to end up with dissolving bones which is what other
doctors have stated is the fate of most people who live to be
very old. Since people in my family lines normally
die between 85 and 95, I have been concerned about osteoporosis because
the folks who did die earlier usually died from the results of a broken
hip. It wasn't fast, usually a year, and it wasn't pleasant and isn't
solved by hip replacement. The fact is, bio-identical estrogen and
progesterone protect your bones from osteoporosis. The incidence of some
form of osteoporosis in the aged is very high. Which means MOST people
will get osteoporosis. MOST WOMEN DON'T GET CANCER.... MOST WOMEN
DO GET OSTEOPOROSIS. A relatively low percentage of women get cancer and
die from it.
A. This email summarizes one of the basic dilemmas regarding the
benefits versus the risks of hormone replacement therapy. Does the
benefit of decreased bone fractures outweigh potential harm from an
increased cancer rate, heart attack, stroke, or other problems that are
related to hormone replacement therapy? Science does not have the full
answers at this time.
Q. In your Jan. 2009 newsletter, you site an
MSNBC news article that reports taking menopause hormones for five years
doubles one's risk of breast cancer. The article clearly stated that the
hormones studied were horse estrogen and synthetic progestin ingested by
mouth. This is quite different than applying a cream of bio-identical
hormones. It may be that these creams increase the risk, as well, but
that is not part of the referenced study, and many contemporary studies
indicate otherwise.
A. Until long term studies are done testing bio-identical
hormones in terms of their effect on breast cancer and how they compare
to synthetic progestins and conjugated equine estrogens, it is premature
to claim that one form has less risk than the other. What if
bioidentical hormones end up being even more potent in stimulating
certain cancers than synthetic progestins or equine estrogens? It took
decades for the medical community to find out the full risks of hormone
replacement and it may take a long time for women who are currently
taking bioidentical hormones, under premature safety assurances by many
natural hormone marketers and promoters, to find out that these
medications have risks that we are currently not aware of. I did mention
in the newsletter
that if you were to use hormones as symptomatic relief for menopausal
symptoms, my impression is that it would be preferable to use natural
hormones. If you are aware of long term studies regarding the safety of
natural hormone use, please let us know.
Q. I received Dr. Sahelian’s January 2009
newsletter article with his comments on using estrogens and progestins
to help with menopause symptoms. I feel it is very important to point
out that the HRT used in the WHI study contained horse estrogen which is
not the same as human estradiol now available in products such as
Estrace and the Vivelle patch. While the horse estrogen does bind to
human estrogen receptors, it does not have the same action as the human
estradiol, ie. It fits in the lock but you can’t turn the key. Also,
since the human body doesn’t have the enzymes necessary to break down
the horse estrogen, it can stay in the body attached to the receptors
for several months. Human estradiol is essentially out of the body in
2 days after you stop treatment. I have
read several books and studies indicating that replacing a women’s estradiol with the so called bioidentical estradiol is very beneficial.
I personally have found this to be the case.
A. Scientists do get important clues by studying the effect of
these hormones on receptors in a laboratory, but until actual human studies are done for
several years with natural estrogens in varying dosages, their
safety will not be known to their
full extent. When ingested orally, these hormones are altered by the
liver before they make it to the cells. Therefore, cell studies in a
laboratory do not give us the full picture. Also, what if we find out
someday that natural hormones stimulate cancers in certain tissues of
the body more potently that the horse estrogens? At this time we don't
have any long terms studies that compare bioidentical hormones to
Premarin.
Other points to keep in mind:
How are we to know for sure whether compounding pharmacies are preparing the
correct bioidentical hormones since there is little or no oversight?
How do we know the right dosages for these bioidentical hormones in terms of
long term use? How many years should one take them? When should one stop using
them?
How do we know which form of estrogen is best: estriol, estradiol, estrone, and
in what proportions? How do we know whether slow steady release / absorption of
these hormones is better or worse that a quick absorption with a high peak and
low valley?
How do we know which is better, oral or topical hormone use?
How do we know whether saliva testing is reliable? How is one to know the right
hormone dosage to use based on saliva testing or blood testing? There is little
evidence that a blood level or saliva level of a hormone can predict exactly the
actual hormone amount a woman needs to take. The dosage of these hormones is
most likely best managed through symptom relief of hot flashes, mood swings,
sleep problems, and other symptoms rather than relying on blood or saliva
levels.
Could natural progesterone have a protective effect on breast cancer but
potentially cause other health issues such as an increased risk for heart rhythm
disturbances?
If you're considering starting hormone treatments to ease the hot and bothersome
symptoms of menopause, keep in mind that you could suffer even more if you ever
stop the therapy. Findings of a study, part of the large-scale Women's Health
Initiative (WHI), may give postmenopausal women pause before starting
replacement of their body's declining levels of estrogen. Evidence seems to
suggest that 25 percent or more of women who start hormones might find it very
difficult to stop them -- ever. Menopause, online May 24, 2010.
My opinion as of 2018
The bottom line is that every woman has to decide for herself whether
the benefits of hormone use, in terms of menopause symptom relief and
potential reduction of osteoporosis or treating other medical issues,
outweighs the potential risks for cancer, heart attack, stroke, or other
serious conditions from HRT use. Does the use of hormone replacement
increase or decrease mortality? The answers are not yet in.
Keep in mind that there is a physiological reason why hormone
levels drop with age. The human body was not meant to be exposed to high
levels of certain hormones with aging. Therefore, any form of hormone
replacement through pills, creams, or shots, and whether synthetic or
bioidentical, is not something the human body is genetically adapted
to. Humans have lived on this planet for a long, long time but it has
been only in the last few decades that doctors started prescribing
hormone replacement therapy to such a large number of women. If, a decade
or two from now, research shows bioidentical hormone use to
be safe, I will wholeheartedly promote their use. Until then, women who are using
these hormones, particularly in high dosages and for prolonged periods,
are taking a gamble. If natural hormone replacement is the only solution
to reducing your menopausal symptoms or taking care of other health
issues you have, use the least dosage that works and for the shortest
period of time. Exercise, weight training, calcium and vitamin D are a
few good options in reducing the risk for osteoporosis. The risk for
heart disease, stroke, and mental decline can be reduced through diet,
exercise, low stress, yoga, deep sleep, and by taking certain natural
herbs and supplements.
I want to emphasize that I am not in favor nor am I against the use
of hormone replacement therapy. I just want women to be aware of all the
benefits and risks and make an informed decision. The quality of life of
many women has improved through HRT, whether synthetic or bioidentical,
while other women have discovered the use of hormones has caused more
problems than benefits. I support a woman's decision, no matter what, as
long as she is informed and knows all the options, benefits and risks.
Menopause hormone replacement therapy
Did you hear the news that fewer women are being diagnosed with breast cancer? Estrogen and progesterone hormone use plummeted after a 2002 study found that
hormone replacement therapy after menopause raised the risk of
breast cancer, heart disease and other problems. Before that, the regimen
was believed to prevent many of these conditions, and doctors prescribed
them as little fountains of youth. The decline in new breast cancer cases
in 2003 is thought to have come because millions of postmenopausal women
stopped hormone replacement therapy in 2002. There appeared to be a 7
percent drop in breast cancer incidence between 2002
and 2003 and most researchers believe it is related to the discontinuation
of the hormones.
My comments: Many of you already know that the estrogen most
commonly prescribed for women as hormone replacement therapy after
menopause is Premarin derived from the urine of pregnant mares (horses).
The progesterone prescribed to women by doctors most often is a synthetic
progestin, not actual progesterone made by the body. Some people claim
that the use of natural bioidentical hormones would not cause as many
problems in women as the use of Premarin or progestins. However I have not
seen any long term studies comparing the two regimens and for the time
being I will assume that the risk for breast cancer in women with the use
of bioidentical hormones is similar until proven otherwise. Lately Suzanne
Somers, the TV actress, has been heavily - and somewhat irresponsibly -
promoting her book suggesting women use bioidentical hormones to improve
their health. I think this is a better option than artificial estrogens
and progestins, but there is no evidence that they are safer and before
you take high doses of these hormones keep in mind that it is a
possibility that future research may show misuse of these bioidentical
hormones carries serious risks. There are two natural hormones -- DHEA and
pregnenolone -- available over the counter. Be cautious with their use
since they can have serious side effects. Hormone supplements are
not to be toyed with
but be treated with respect, even if they are available without a
prescription.
Hormone replacement therapy side effects, danger, caution
and risk
Tumors in patients who use hormone replacement therapy are larger and more
likely to spread beyond the breast compared with those who do not use HRT. Pro and cons of hormone replacement therapy
continue to be debated, however there now appears to be more cons than pros.
Research scientists at the Northern California Cancer Center and Kaiser
Permanente's Division of Research have found significant reductions in both the
use of hormone replacement therapy and the incidence of breast cancer in
California in the years following the release of the 2002 Women's Health
Initiative (WHI) trial results. Previous studies have shown that long-term use
of hormone replacement therapy is linked to increased risk of breast cancer. For
example, the WHI randomized trial and other studies discovered that estrogen
plus progestin hormone therapy use increased a woman's risk of breast cancer.
This new analysis, the first to use the most recent 2004 California Cancer
Registry data, supports the theory that women who discontinue hormone
replacement therapy use may reduce their chances of being diagnosed with breast
cancer. "Hormone therapy use dropped 68 percent between 2001 and 2003, and
shortly thereafter we saw breast cancer rates drop by 10 to 11 percent. This
drop was sustained in 2004, which tells us that the decline wasn't just a
fluke," notes Dr. Christina A. Clarke, the Northern California Cancer Center
scientist who led the study. In the current study, researchers examined yearly
prevalence of hormone therapy use and breast cancer incidence from 1994 to 2003
for women ages 50 to 74 in Kaiser Permanente's Northern California Region and in
the 2004 California Cancer Registry. They found consistent evidence of
corresponding trends in decline in both hormone therapy use and breast cancer
incidence.
Review of WHI study by Lou
Mancano, M.D.
Risks: In the Women's Health Initiative, combined estrogen-progestin therapy was
associated with a significant increase in coronary events. CHD included nonfatal
myocardial infarction and death due to CHD. There were 6
additional coronary events per 10,000 person-years on estrogen and progesterone
and no additonal coronary events for estrogen alone. Data from Manson, JE, Hsia,
J, Johnson, KC, et al. Estrogen plus progestin and the risk of coronary heart
disease. N Engl J Med 2003; 349:523. There were 8 additional breast cancers per
10,000 person-years on estrogen and progesterone. There were 18 additional
thromboembolic events per 10,000 person-years on estrogen and progesterone.
Benefits: In the Women's Health Initiative, combined estrogen-progestin
replacement therapy was associated with significant reduction in hip fracture (5
fewer hip fractures per 10,000 person-years, HR 0.7, unadjusted 95 percent CI
0.4 to 1.0). Data from Risks and benefits of estrogen and progestin in healthy
postmenopausal women: principal results from the Women's Health Initiative
randomized controlled trial. JAMA 2002. HRT seemed to protect against
Colon Cancer with 6 fewer cancers per 10,000 person-years. Lou Mancano, M.D.
2009.
After hysterectomy hormone replacement therapy benefit
After a hysterectomy and/or bilateral ovariectomy, many women will
experience hot flashes and lack of libido or sex drive, loss of bone mass,
deterioration of the urinary and genital tissues. For women who undergo a
hysterectomy and/or bilateral ovariectomy the effect of estrogen and
progesterone deficiency is profound. Hormone replacement therapy benefit for a
woman include stronger bones thus reducing the risk for osteoporosis, and
improvement in sexual energy.
Male hormone replacement therapy HRT - hormone replacement
therapy for man
The use of hormone replacement therapy in men is controversial. Levels of DHEA
and testosterone drop as we age, but there is no proof as of now that hormone
replacement therapy with testosterone or DHEA prolongs life span. It may be
possible to enhance quality of life along with libido and vitality by taking
certain hormones, but if you plan to do so, use very, very, low amounts of
hormones and take frequent breaks.
Q. I have been a fan for many years and appreciate your
insights into supplements and various nutritional therapies. I am 67 years old,
and have recently become interested in DHEA and Pregnenolone, but am extremely
frustrated in my search for protocols for taking the two together. I have seen
articles recommending morning and evening, with food and without - very
confusing. And have not found anything specifying on the best way to use both
together. Can you advise on best ways to take both, whether they can be taken
simultaneously or should be spaced apart. Whether divided doses throughout the
day. Better with food or on an empty stomach, or sublingually? And do any other
supplements help to optimize their effects?
A. The reason there are no such protocol is because so little
research is available regarding each one, and even less so together. The most
practical approach is to take one or the other or both in the morning with or
without food, but to keep the dosages extremely low, for a total of less than 10
mg together, and a couple of days off a week.
Drug for hormone replacement
therapy
The medicines used for hormone replacement therapy are hormones, not drugs.
Questions
Q. First let me say how much I have enjoy reading your postings and information
on your websites. I have subscribed to your newsletters and look forward to
receiving those regularly. I am constantly learning!! I am a 51 year old healthy
female who had been taking synthetic hormones in the form of an estradiol patch
(highest dose available for 1.5 years) and a Prometrium tablet for about 1 year
until November 2006. I was not happy with this form of female hormone
replacement therapy. Yes, it did resolve the hot flashes and the mood swings
were manageable but I didn't like taking synthetic hormones. I was introduced to
your website and pregnenolone while searching for other options. I started
taking about 2.5 mg of pregnenolone orally (from a 15mg capsule). I am
experiencing lower back pain and leg cramps similar to the cramps I had when I
started a menstrual cycle. When I began taking the Prometrium (October 2005), my
cycles stopped. I have had 3 since then and experienced spotting on occasion.
Right now, I am experiencing hot flashes - day and night - and the cramping. I
am prepared to do a saliva test to determine how my body is handling the stress
hormones and what exactly is going on with my hormones. Should I be concerned
about the leg cramps (which wake me up) and should I discontinue using the
pregnenolone or increase the dose for the symptoms of menopause?
A. This is a personal question that you need to discuss with your
doctor regarding the best option in your case for optimal female hormone
replacement therapy. Without knowing your full history, blood work, or doing a
medical evaluation, we would not be able to provide accurate suggestions.
Q. Are you familiar with the French study on the use of
bio identical hormones? It was published in a journal called Maturitas. It says
tens of thousands of French women were studied who used bio identical hormones.
The study claims that women who used the Bio identicals, had no elevated risks
of cancer. I am on bioidentical hormones and I am researching any studies that
show the safety of these hormones. I wondered what you thought of this French
study.
Could transdermal estradiol plus progesterone be a safer
postmenopausal HRT? A review. Marc L’Hermitea, Tommaso Simoncinib, Sarah Fullera,
Andrea Riccardo Genazzanib. Published online 22 August 2008.
Hormone replacement therapy (HRT) in young postmenopausal women is
a safe and effective tool to counteract climacteric symptoms and to prevent
long-term degenerative diseases, such as osteoporotic fractures, cardiovascular
disease, diabetes mellitus and possibly cognitive impairment. The different
types of HRT offer to many extent comparable efficacies on symptoms control;
however, the expert selection of specific compounds, doses or routes of
administration can provide significant clinical advantages. This paper reviews
the role of the non-oral route of administration of sex steroids in the clinical
management of postmenopausal women. Non-orally administered estrogens,
minimizing the hepatic induction of clotting factors and others proteins
associated with the first-pass effect, are associated with potential advantages
on the cardiovascular system. In particular, the risk of developing deep vein
thrombosis or pulmonary thromboembolism is negligible in comparison to that
associated with oral estrogens. In addition, recent indications suggest
potential advantages for blood pressure control with non-oral estrogens. To the
same extent, a growing literature suggests that the progestins used in
association with estrogens may not be equivalent. Recent evidence indeed shows
that natural progesterone displays a favorable action on the vessels and on the
brain, while this might not be true for some synthetic progestins. Compelling
indications also exist that differences might also be present for the risk of
developing breast cancer, with recent trials indicating that the association of
natural progesterone with estrogens confers less or even no risk of breast
cancer as opposed to the use of other synthetic progestins. In conclusion, while
all types of hormone replacement therapies are safe and effective and confer
significant benefits in the long-term when initiated in young postmenopausal
women, in specific clinical settings the choice of the transdermal route of
administration of estrogens and the use of natural progesterone might offer
significant benefits and added safety. Keywords: Micronized progesterone,
Transdermal estrogens, MPA, Postmenopause-hormonal replacement therapy,
Cardiovascular risk, Hypertension, Breast cancer, Venous thromboembolism.
A. The first sentence of this review makes me suspect that the
individuals who wrote this review do not have a balanced position. They say,
"Hormone replacement therapy (HRT) in young postmenopausal women is a safe and
effective tool...." Most scientists are not as cavalier as these doctors. It
would take at least several 10 to 15 year long studies with bioidentical
hormones, in oral and dermal forms, in various dosages, and in various
combinations of estrogen and progesterone, to have a better understanding of
their long term benefits and side effects. To my knowledge, these types of
studies for these time periods have not yet been done as of 2009. When Premarin
and progestins first became available decades ago for hormone replacement
therapy, many doctors were assuring their patients that they were safe. It took
several decades to find out that serious problems could occur. I do not know
Marc L’Hermitea, Tommaso Simoncinib, Sarah Fullera, Andrea Riccardo Genazzanib
and do not know if they have any affiliations with pharmaceutical companies that
sell these hormones.
I am a 37-year-old female who has been successfully
using natural progesterone cream for at least 11 years. You recommend "taking
frequent breaks" from HRT. What do you mean by that? I always stop using the
product just before my menses ( or when they begin, if they begin early), and
the only prolonged break I ever took was probably 10 years ago for about 6 wks,
at the end of which I felt like I was losing my mind. Thinking of quitting
progesterone, even for a time, is frightening to me, since I dealt with severe
mood swings and extreme insomnia. Progesterone has made life manageable. Still,
I want to be open to what is healthiest for my body. Any helpful info will be
greatly appreciated.
Different people have different needs regarding any kind of
supplement or hormone replacement therapy. As a general rule, due to the fact
that excess hormone use may have long term health consequences, it is best to
use the least amount of these hormones and as fewest days. Each person needs to
find out for themselves what the right dosage and frequency of use would be for
their unique needs.