Is HRT Safe?

Most of us post-menopausal women remember the scare about the effects of estrogen replacement when the Women’s Health Initiative Study (WHI) was abruptly stopped early because the researchers were seeing an increased incidence of breast cancer, heart disease, stroke, and blood clots. With the big scare women dropped their HRT. Then several years later the incidence of hip fractures increased.

So what are we supposed to do? Suffer from hip fractures, hot flashes, dry skin and vagina and more urinary tract infections or take our chance with HRT and risk getting breast cancer, an increase in heart disease, stroke and blood clots? The choices do not look very good.

But let’s take a closer look at the WHI study.

First of all, the 16,000 participants in the trial did not have testing to determine their hormone levels before receiving the HRT. Maybe some of them had perfectly adequate levels of hormones to begin with.

Second, what kind of hormones were these women taking? In one part of the WHI study the women took PremPro (Premarin and synthesized progesterone, medroxyprogesterone), in another part they ingested Premarin (derived from Pregnant Mare’s Urine) only. In the prior article Bioidentical Hormone Replacement – the Doctor and Lab Work Part 2 you discovered that bioidentical hormones function more like the hormones that you’re body would make, fitting well into the cell membrane to stimulate the needed function in the cell. Synthetic hormones like Premarin and medroxyprogesterone may not fit into the cell membrane as well.

Third, they were given a one size fits all dose of the drugs, probably inducing levels of estrogen in their blood and tissues that were way too high. Most doctors who prescribe patented drugs for HRT still do not follow blood or tissue levels of hormones to determine the dose of drug that raises the hormone levels to optimal amounts without causing levels that are too high.

On the other hand doctors who prescribe Bioidentical hormones order lab tests to check current hormone levels before initiating hormone replacement and then follow-up hormone profile tests until the levels stabilize at the optimal range. In post-menopausal women, they usually then check the hormone profile at the yearly exam.

Optimizing and individualizing the hormonal dose makes HRT much safer. Some of the main stream web sites still say that the body cannot tell the difference between Bioidentical hormones and synthetic ones. If they honestly looked at the simple picture of the lock and key concept I think they would start to take a closer look at the differences in the 2 types of hormones. Keep in mind that main stream medicine and the FDA are greatly influenced by the drug companies who want to keep their profits high.

The main stream sites also say that Bioidentical hormones have not been proven to be safer. But the evidence is beginning to accumulate in regard to the superiority and safety of Bioidentical Hormone Therapy (BHRT).

I have included the abstract of the following study in its entirety as it states very well the difference between HRT and BHRT. The words in parentheses are mine to explain some of the scientific terms.

A comprehensive review of the safety and efficacy of bioidentical hormones for the management of menopause and related health risks.

Moskowitz D. Moskowitz, Deborah. Wellness Designed, LLC.

“Abstract: Numerous forms of estrogens and progestins (types of progesterone) are utilized for the treatment of menopausal complaints and associated conditions that occur temporally. Although known to be different with respect to molecular structure, receptor affinity (the way it attaches to the cell membrane), metabolism, and other physiological traits, most have been treated as if they were clinically identical.

The majority of these hormone preparations, commonly referred to as hormone replacement therapy (HRT), should perhaps be more aptly referred to as hormone substitution therapy, as most of the therapies utilized do not exactly match those produced in the body.

Research indicates these synthetic hormones vary clinically in safety and efficacy. As such, women and their physicians have, in increasing numbers, been opting for the use of bioidentical hormones; i.e., those that match the structure and function of hormones produced in the body. With greater utilization and research surrounding bioidentical hormones, the differences can now begin to be fully assessed and appreciated.

This article reviews the disparities between synthetic and bioidentical estrogens and progestins/progesterone with respect to safety and efficacy; special attention is devoted to clinical outcomes in the breast, endometrium (lining of the uterus), bone, cardiovascular system, and brain.

The studies reviewed suggest bioidentical progesterone does not have a negative effect on blood lipids (cholesterol and triglycerides) or vasculature (blood vessels) as do many synthetic progestins, and may carry less risk with respect to breast cancer incidence.

Studies of both bioidentical estrogens and progesterone suggest a reduced risk of blood clots compared to non-bioidentical preparations. Bioidentical hormone preparations have demonstrated effectiveness in addressing menopausal symptoms. The author advocates for continued research on bioidentical hormones and concludes there is currently sufficient evidence to support their preferred use over that of their synthetic cousins. PMID: 17217322”

Blessings,

Dr. Jo