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Why Might You Want to Use Hormone Replacement Therapy?

Why Might You Want to Use Hormone Replacement Therapy?

You have probably heard a lot about hormone replacement therapy, both good and bad. Let’s look at some of the details of why you might consider using hormone replacement therapy as part of comprehensive, effective, and safe support for your overall health.

Why Should I Use Bio-identical Hormones?

It could lengthen your healthy, functional life span.
It can help retain physical vigor, mental clarity and youthful appearance.
It has anti-aging effects on:

  • Skin
  • Hair
  • Sexual health
  • Brain function
  • Bone health
  • Maintaining ideal body weight/weight loss
  • Blood sugar control
Bioidentical Hormones
It Helps Relieve Menopausal Symptoms
  • Hot flashes
  • Mood swings
  • Insomnia
  • Vaginal dryness
  • Sexual dysfunction
  • PMS in those still menstruating
  • Urinary incontinence
  • Frequent urinary tract infections
  • Anxiety/depression/irritability
  • Heart palpitations
  • Stiffness/soreness
  • Possible decreased risk of dementia
  • Reduces risk of colon cancer
  • Decreased risk of macular degeneration
  • Decreased risk of diabetes
Some Interesting Information to Ponder
  • Only in the last 100 years have women survived past menopause.
  • Presently we spend 1/3 of our life post-menopausal.
  • Average life span for Americans almost doubled to 76.5 years of age.

INFORMATION ON SPECIFIC HORMONES

Estrogen
  • Produced in ovaries, fat cells, and male testes (yes, men need estrogen too!)
  • There are many estrogen receptors in reproductive organs, genital tissue, breast tissue, skin, brain.
  • Levels decline around age 40, the average age of menopause is 51.
  • Symptoms of withdrawal of estrogen, through age or by stopping supplementation:
    • Hot flashes
    • Insomnia
    • Racing mind, especially at night
    • Weight gain (worse in hips/thighs, buttocks)
    • Back/joint pain
    • Heart palpitations
    • Depression/anxiety
Other Estrogen Deficiency Issues
  • Possible increased risk of dementia & colon cancer.
  • Decreased lean body mass (muscle mass).
  • Loss of skin tone, firmness & elasticity.
  • Dry skin and mucous membranes (eyes, nose, vagina).
  • Reduced sex drive.
  • Hair loss
  • Bone loss
Progesterone Deficiency Issues
Symptoms of Estrogen Dominance in Relationship to Progesterone
  • Premenstrual syndrome (PMS)
  • Uterine fibroids
  • Endometriosis
  • Breast tenderness and pain
  • Breast lumps/cysts
  • Consider estrogen-like compounds in our environment, which may increase effective estrogen levels.
Testosterone
  • Energizing hormone>
  • Natural anti-depressant
  • Supports sex drive/function
  • Maintains health and sensitivity of the vaginal tissues.
  • Maintains lean body mass/muscle growth & repair.
  • Prevents heart disease
  • Skin health
  • Bone health

THE SAFETY OF HORMONE REPLACEMENT THERAPY: Important Studies

The Women’s Health Initiative (WHI) Study

Participants:  16,608 women, age 50-79.

Hormones used: Premarin (not bioidentical – name brand of drug, a type of estrogen derived from horse urine, not found in human bodies) + Medroxyprogesterone (a progestin, this molecule is also not naturally found in human body).

The study was halted after 5.2 years due to a slight increase in breast cancer rates in the participants. To summarize: The initial review of the WHI study concluded that… Over one year, 10,000 women on Premarin + progestin compared to placebo may have:

  • 8 more strokes (again not statistically significant)
  • 18 more thromboembolic events
  • 8 more invasive breast cancers
  • 6 fewer colorectal cancers
  • 5 fewer
  • 7 more CHD (Coronary Heart Disease) events (increased risk of CHD was not statistically significant*)
  • hip fractures

*“Not statistically significant” means that there was ultimately no increase in risk.

Breakdown of the Risk of Stroke/Blood Clots in the Women’s Health Initiative (WHI) Study

The number of cardiac events decreased with the increased duration of hormone replacement therapy in both WHI clinical trials.

The WHI data showed no statistically significant increase in risk (stroke in ages 50-59); … even if statistically increased, as found in the Nurses’ Health Study, the low prevalence in this age group makes the risk extremely small.

The risk of venous thrombosis (blood clots) is approximately two-fold higher with standard doses of oral (we use topical) hormone replacement therapy (HRT), but is a rare event (as the) prevalence is low in a healthy woman under 60 years of age. The risk of blood clots is possibly less with transdermal (through the skin, or topical) estrogen, compared with oral estrogen therapy.

Problems with the (WHI) Study

There were a number of possible factors that could have caused the slightly increased incidence of adverse events.

  • The average age of the participants was high: 63 years, or 12 years post menopause
  • 70% were 60-79 years old
  • 35% were overweight, 34% obese
  • 40% were smokers
  • 36% had hypertension
  • 42% discontinued treatment during the study
  • We can’t use the results to generalize about other hormonal preparations than the exact ones used in the study.
  • The WHI doesn’t tell us anything about healthy women starting hormones around menopause.
  • Many women in the study already had a high cardiovascular risk.<
  • There are questions about the methods of statistical analysis used in the study.
Hormone Replacement Therapy (HRT) and Breast Cancer (BC)
  • HRT is unlikely to be the cause of BC. It takes approximately 10 years to develop a 1 cm breast cancer tumor.
  • There is at most a modest association between Estrogen Replacement Therapy use and breast cancer risk.
  • Breast cancers diagnosed during HRT use are more likely to contain estrogen receptors (ER), are less aggressive, and are associated with a more favorable prognosis than non-ER- associated tumors.
  • Most reports indicate no increase in breast cancer mortality (death) in HRT users and the increased risk associated with HRT is reduced after HRT is discontinued.
  • HRT can fuel a pre-existing cancer to grow so it is important to stay up to date on some sort of breast imaging + get regular follow up.
Progesterone Replacement and Breast Cancer

There is a lower risk of breast cancer using progesterone (“bio-identical”) vs medroxyprogesterone/progestins (non-bioidentical) as a supplement.

 An important French study on the type of progesterone used and breast cancer:

Postmenopausal primate model (Monkey study).

Risk Factors for Breast Cancer
  • Family history – One 1st degree relative equals 2x increased risk (85% of breast cancer patients have no family history).
  • Alcohol consumption – 2 to 5 drinks/day equals 1.5x risk.
  • Low physical activity.
  • Early age at menarche (first menstrual period)
  • Delayed menopause
  • Never having children (nulliparity)
  • Late age at first full term pregnancy (>30)
  • High body weight after menopause
  • High insulin/blood sugar
  • Recent contraceptive pill use (Oral Contraceptives) – it takes 10 years off to lower the increased risk
  • 5 to 10% genetic risk factors
Colon Cancer and HRT
  • Colon cancer is the 3rd leading cause of cancer death in men and women.
  • Pooled analysis of HRT studies performed on Caucasian women suggests a 30% reduction in colon carcinoma risk among current HRT users, with less protection seen after HRT cessation.
Ovarian Cancer and HRT
  • The evidence concerning a possible positive relationship between HRT use and ovarian cancer risk is less consistent than that for endometrial and breast cancer. Most data exclude any strong association between HRT use and ovarian cancer risk, even if published studies analyzing such a relationship have shown controversial results.
HRT and Cardiovascular Disease (Heart Disease)
  • HRT is not contraindicated in women with hypertension and, in some cases, HRT may even reduce blood pressure.
  • HRT can be given around the age of menopause without increasing the risk of coronary heart disease and may even decrease the risk in this age group.
  • HRT is contraindicated in women with a history of a heart attack, stroke, or pulmonary embolism.
Hormones and Brain Health
HRT and Macular Degeneration

PATIENTS WITH THE FOLLOWING CONDITIONS SHOULD NOT USE HRT

  • Uterine cancer
  • Undiagnosed vaginal bleeding
  • Pregnancy
  • Breast cancer
  • History of blood clots (although route of administration may make the difference)
  • Severe liver and gallbladder disease
How Do I Schedule an Appointment?

Use the contacts below or call the office at (707) 575-5180.

REFERENCES

See GMA Articles and Podcasts on Bio-identical Hormones

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