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  Post-menopausal HRT
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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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