What lessons have we learned from the Women’s Health Initiative?
Should I stop hormone replacement therapy?
Will hormone replacement therapy increase my risk of breast cancer?
Will estrogen increase my risk of heart disease, stroke, or blood clots?
Is the type of estrogen used important?
Is the method of administration important?
What are other undisputed benefits of hormone replacement therapy?
Should my estrogen blood level be monitored while I am administering hormone replacement?
Does hormone replacement therapy cause dementia or cognitive impairment in postmenopausal women?
It is abundantly clear that Premarin, Provera, and Prempro should not have been the types of hormones used in that study, and all should be taken off the market by the F.D.A. If those were drugs used by men, they would long since have been removed. That does not, however, mean that hormone replacement using non-oral human estradiol and progesterone is included in the same negative results. Indeed, exactly the opposite is true.
If you are taking Premarin, Provera, or Prempro, the drugs used in the Women’s Health Initiative Study that has been so widely publicized in the last years, the answer is YES! Does that mean you should stop other hormone replacement regimes? NO! It means you should switch to non-oral human estradiol and human progesterone in cream, gel, patch, or pellet form and monitor “free” estradiol and progesterone levels in the blood to assure correct dosage.
If there is any increased risk, it is minimal. Various studies show an increase of zero to 5%. Most authorities agree that estrogen speeds up the rate at which breast cancer grows once it is there, but doesn’t actually cause it in the first place. This can work to your advantage, allowing you to discover the tumor before it has a chance to metastasize (spread). Which explains why women who discover breast cancer while taking hormones have a better prognosis than those who develop it while not taking hormones. By comparison, one half of a drink of alcohol per day increases your breast cancer risk by 30%. Living in Marin County, California; Cape Cod, Massachusetts or Long Island, New York raises your breast cancer risk by 70%. Five studies now show a better prognosis for women who have had breast cancer and continue to take estrogen. Family history of breast cancer is not a deterrent to estrogen therapy.
Herein lies the current controversy. The hallmark Harvard Nurses Study, which has been ongoing since the early 1970s, shows a 61% decreased risk of cardiovascular disease in hormone users. However the 2002 Women’s Health Initiative study shows a 29% increase. Why the huge discrepancy? In my view the discrepancy occurred because two-thirds of the women in the WHI study did not start taking the estrogen until after age 60. Pre-menopausal women nonsmokers rarely have fatal heart attacks. When estrogen (estradiol) production by the ovaries ceases between ages 45 and 55 (menopause) heart attacks in women (but not men) rise precipitously, equaling the rate in men by age 60 and surpassing men by age 65. Once calcium plaques have occurred in coronary arteries or elsewhere in the body, neither estrogen nor anything else will reverse them – the damage is done. That is why it is important to start hormone replacement therapy as soon as your blood levels begin to fall, usually during your early forties.
Definitely! Almost all studies in this country have been done using Premarin, which is horse estrogen, and Provera, which is a synthetic progesterone. Neither makes sense. Human bio-identical estradiol and bio-identical progesterone should be used for humans.
Yes! How you take hormones is just as important as the type of hormone you take. Oral administration of hormones allows a “first pass” effect through the liver, altering them completely and increasing the risk of abnormal blood clotting, gallstones, and high blood pressure. Estrogen and progesterone should be administered non-orally (not by mouth) in the form of cream, gel, pellets, or patches.
Some of the benefits of HRT are: 65% decrease in colorectal cancer; 70% protection against hip fracture; prevention of vaginal atrophy, which causes decreased lubrication and painful intercourse; improved mental function including better memory, mood, cognition, and sleep; and improved bladder function with less urinary leakage.
As with any other hormone therapy, blood levels should be monitored. However it is very important to have a correct test: A free-estradiol test is the one I recommend. As to monitoring your estrogen levels with a total estradiol (kit test) or by measuring follicle-stimulating hormones in the blood, both tests are totally inaccurate and misleading.
This issue is another example of media distortion. A recent article reported that these conditions doubled with hormone use. The women in the study were using orally administered hormones and started taking the hormones after age 65, much too late to prevent cerebral arterial changes. Another study showed a 50% protection for women who started taking hormones between ages 45 and 60, and continued for ten years.
Content provided on this website is for general informational or educational use only and is not intended to be used as medical advice in specific situations. See your doctor about hormone medication.