Women's Health

Hormone Replacement Therapy

July 2002 brought "breaking news" in health care that left me feeling extremely validated. After all, I've only been speaking out against hormone replacement therapy for the last 15 years! I believe it was the National Institutes of Health that had been conducting a huge longitudinal study on hormone replacement therapy (HRT). A longitudinal study is based on tracking many women over many years as they use hormones, and watching what happens. The study was abruptly cancelled due to the severity of the side effects.

The researchers made the following "amazing" discoveries:
1. HRT markedly increases the risk of cancer. The figures are 8 more women out of 10,000 will develop cancer of the breast.
2. HRT does not protect against heart and cardiovascular disease. In fact, it markedly increases the risk of cardiovascular events: out of 10,000 women, 7 more will suffer a heart attack, 8 more will have a stroke, and 18 more will experience blood clots.
3. HRT does not protect against osteoporosis.

These findings should come as no surprise to anyone who has followed the history of hormone use in the United States. It began with diethylstilbesterol (DES) for pregnant women to prevent miscarriage. The results long term: an increase in reproductive cancers among the children exposed to exogenous estrogen in the womb.

Then, came the birth control pill (BCP). The initial formulas were a debacle - high doses of unopposed estrogen. The result: strokes, hypertension and heart attacks in the very young women who were the first users. (My feeling: anyone who uses a new drug is volunteering to be a guinea pig. Of course, that's not how it's presented to you, the public.) Interestingly, the doses were not much higher than the amount of estrogen in a typical Premarin(R) prescription.

The cancer connection actually should have been a "duh." For many years, the Physicians' Desk Reference stated unequivocally that no woman should take estrogen for more than 6 months because it increases the risk of cancer 9 times. That warning was suppressed in recent editions as more and more women were prescribed lifetime HRT. All the research supports the data that breast cancer risk increases in direct proportion to lifetime estrogen exposure. The older you are, the higher your risk. If you've never been pregnant (during which time you have very low estrogen and relatively high progesterone), your risk increases. If you've taken BCP or HRT, your risk increases. Also, both smoking and alcohol increase the risk, because both of these drugs impair the liver's ability to detoxify estrogen, increasing the lifetime tissue exposure.

Finally, the data has been available for years that perimenopausal women start losing bone mass before they stop menstruating. When they become anovulatory, they no longer produce progesterone and begin losing bone mass. Natural progesterone arrests bone loss, but the progestins found in HRT do not. Progestins are actually closer to male hormones in their action than they are to progesterone. The problem with progesterone (from a pharmaceutical company point of view) is that, it can't be patented, because it is a natural product. Also, oral delivery of progesterone is not very effective, because it is immediately metabolized by the liver. Transdermal or sublingual delivery is much more effective. The data on osteoporosis indicates that natural progesterone combined with appropriate calcium supplementation (which includes your vitamin D status, your parathyroid status, as well as adequate amounts of bone matrix) maintains and restores bone mass. Of course, you have to do mild weight-bearing exercise and get a little sun, but those lifestyle changes are much safer than exposing yourself daily to a dose of carcinogens.

The other very important piece of data that has not been well publicized is that the women at highest risk for cancer from HRT are the women taking Premarin(R). Premarin(R) consists of more than 100 horse estrogens which are conjugated to make them longer acting. Premarin(R) is actually made from pregnant mare's urine. Because these compounds are foreign to the human body, they can only be metabolized down the 4-hydroxestrone (4-OH) pathway. Unfortunately, the 4-OH pathway is the most carcinogenic of the 3 pathways in the body; and, the intermediate products are much more carcinogenic than the estrogens themselves.

There are several interesting aspects to what's currently going on in both the media and with traditional doctors. I have been fascinated as I watch them try to back-track without really seeming to and then propose strategies that are basically more of the same. I have heard at least 3 medical reporters (most of them MDs) advise women to simply switch to herbal estrogen (black cohosh); and, then, of course, go on to encourage women to take Fosamax(R) and prescription calcitonin for osteoporosis while giving lip service to the notion that calcium supplementation is helpful. This is still an allopathic approach: medicating menopause, rather than balancing the underlying physiologic pathways. Even more importantly, it continues the pattern of medicating women for menopause and devil take the side effects. At the RFHC, I have repeatedly reversed osteopenia (bone loss, the first step towards osteoporosis) with the appropriate, personalized supplementation program.

I clearly remember when the drug companies began pushing hormone replacement therapy as they realized the size of the baby-boom menopause market. And, I watched in dismay as they had television "specials" designed to terrify women with the idea that their bones would crumble and they would all die of a heart attack 10 years after entering menopause!

Speaking of side effects: Are you aware that Fosamax(R) calcifies the soft tissues, particularly the esophagus? The result is a painful and serious condition called achlasia wherein you lose the ability to swallow or, at best, it becomes very painful. Fosamax(R) also makes the bones brittle, causing concern that it may actually increase the risk of hip fracture rather than reducing it.

So, what is a woman to do? Let me say, first of all, that there is no one solution for every woman. It is a matter of balancing your metabolism to achieve optimum results. One of the tools we have available is a hormone assessment panel which shows how you personally are metabolizing estrogen, your adrenal status and your DHEA sulfate stores. Those last two items are crucial, since all of your estrogen post-menopausally comes from your adrenals. DHEA provides your body with the precursor to both adrenal hormones and androgens, which maintain your body strength and your libido. Interestingly, low dose DHEA supplementation in women is not masculinizing. The body converts just as much as it needs. Another critical factor is your insulin status and whether or not you are insulin resistant, since excessive production of insulin over stimulates the production of sex hormones. Once we have determined your personal metabolic profile, I can then recommend the appropriate supplements to optimize your health. In severe cases, small amounts of phytoestrogens can be used until your hot flashes subside. However, I don't recommend staying on even these mild agents long-term.

Basically, as with everything else we do here at the RFHC, I can personalize a program for you to get you through menopause comfortably and naturally. If you or someone you love needs to get off of HRT or needs help with menopause, call and make an appointment for a consultation. At that time, we can address your personal situation in greater detail.

Forgive me if this article seems angrier than usual. My mother died of breast cancer induced by Premarin(R) over 25 years ago. Her doctor admitted that to my father after performing a super radical mastectomy, and subjecting my mom to intense radiation therapy. After all of that, he told my father that she had less than a year to live, and that he was sorry he had prescribed Premarin(R) for her after her hysterectomy 5 years before. He was devastated and retired just a month after my mom's surgery. I get angry when I realize there are thousands of other women and doctors who have been similarly victimized by the drug companies.

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