“Women don’t know what to believe anymore,”
says Shelley R. Salpeter, MD, director of medicine consultation services at Santa Clara Valley Medical Center in San Jose, Calif.
The Basics of Hormone Replacement Therapy
Hormone Replacement Therapy is used to replace two female hormones, estrogen and progesterone. Once a woman reaches menopause, her body’s levels of these hormones drastically drop, and this can cause very unpleasant side effects, such as hot flashes, vaginal dryness, severe mood swings, sleeplessness, and physical ailments like osteoporosis. The symptoms will eventually disappear over time, although the risk of osteoporosis won’t necessarily lessen. Unfortunately for most of us, we will be faced with these symptoms once menopause hits. Hormone Replacement Therapy is an option that works for many women, but there are pro’s and con’s to the therapy.
“If a woman in early menopause has low bone density, high cholesterol, mood changes, and sleep problems, she could just take one medicine — estrogen — instead of four,”
says Lynne T. Shuster, MD, director of the Women’s Health Clinic at the Mayo Clinic in Rochester, Minn.
As we have seen in part 2/3, estrogen has a unique role namely reproduction. No other hormone can be held responsable. But estrogen, one of the female hormones, plays other roles in the body besides reproduction. It increases good cholesterol levels and helps the body use calcium more efficiently, thereby strengthening the bones. This is why doctors prescribe often the lowest dose of estrogen possible that will relieve menopausal symptoms, especially in women who have had a hysterectomy.
Progesterone should be used in conjunction with estrogen in HRT in women who have a uterus. This is because the risk of uterine cancer is increased, particularly cancer of the endometrium that lines the uterus.
Once menopause has begun, the endometrial cells are not sloughed off each month, and the build-up of cells increases the risk of cancer. By adding progesterone, the risk is lowered, because progesterone thins the endometrium. This type of Hormone Replacement Therapy is called Estrogen/Progesterone/Progestin Hormone Replacement Therapy. Progestin is the synthetic form of progesterone.
Hormone Replacement Therapy Benefits and Risks
Hormone Replacement Therapy has benefits and risks. It is important to talk to a doctor and weigh the risks for each individual, because some people are more at risk than others when replacing female hormones.
Information that is taken into account includes age, symptoms experienced, how long since menopause began, if it began early, and if it occurred as a result of surgery.
Other factors taken into account are family history of cardiovascular disease, thrombosis, and cancer, and an individual history of cardiovascular disease, and breast cancer.
Benefits of Hormone Replacement Therapy can be summed up as the benefits of female hormones such as estrogen and progestrone in particular. But the benefits are relief from menopausal symptoms and protection from osteoporosis and the risk of broken bones. Starting Hormone Replacement Therapy in the early stages of menopause carries benefits such as a lower risk of stroke, dementia and cardiovascular disease.
A risk associated with female hormone replacement therapy is breast cancer, because estrogen encourages formation of breast tissue.
Other risks include cardiovascular disease, stroke, deep vein thrombosis (blood clots form in veins deep in the body), and pulmonary embolism (artery blockage in the lungs).
I believe it is good to know that a more recent study of 2014 , but on post-menopausal ladies, published in the Canadian Medical Association Journal provided evidence of a risk for acute pancreatitis caused by Hormone Replacement Therapy. The results showed that women who are currently using Hormone Replacement Therapy and those who had used it in the past had a higher incidence of this disease. The study has evidence that using Hormone Replacement Therapy systemically and/or for more than ten years is a factor that increases this risk.
The riscs cited above (besides the latter one on acute pancreatitis) are the riscs that women commonly know.
But what kind of risk are we actually talking about
It all started with the Journal American Medical Association that came with the first results of research. This first research was done by Women’s Health Initiative (WHI) some 15 years ago. The WHI researched pro’s and cons of hormone replacement therapy with healthy American women. One group took daily HRT (0.625mg oestrogens – Premarin – with 2.5 mg medroxyprogesterone acetate – Premplus -) and the other group took no HRT. Over a period of five years. They concluded the above risks. But I think it is most interesting to read these statemenst in absolute figures. So here they are: the results showed that for 10.000 women per year there is per year:
- an increase with
- 7 heart attacks
- 8 cerebral hemorrhages,
- 18 thromboses,
- 8 thromboses with pulmonary embolism and
- 8 breast carcinomas
- a decrease with
- 6 colon cancers
- 5 hip fractures
I am not defending Hormone Replacement Therapy but I think it is can never hurt to know the facts. So everyone can decide for themselves, without the dogma’s.
Bioidentical Female Hormones in Hormone Replacement Therapy
Proponents of bioidentical female hormones say they are derived from sources that occur naturally, such as soy and yams, and that they are exactly the same structures as the female hormones being replaced. The body can use them in every way it could use the original, which leads to fewer side effects. They are also designed specifically for the individual’s needs. Synthetic hormones are purposely made to be the same to make it possible for them to be patented.
Opponents of bioidentical hormones say that they aren’t given the same rigorous quality assurance standards that commercially available hormones must meet. They also argue that they have little scientific support or advantage over synthetic female hormones.
They point out that, although the source of bioidentical hormones is natural, they are still commercially processed.
Another argument is that synthetic hormones do not exclude them from originating from a natural source. Estrace, Climara and Vivelle-Dot, and Prometrium, a natural progesterone, come from plants.
FDA Approved Bioidentical and Synthetic Hormones
In 2009, the FDA published an article called “FDA Approved Bioidentical Hormones.” They have approved more than 20 bioidentical hormones. They also put in some of the synthetic female hormones that have been approved. They specifically say that bioidentical hormones are able to be metabolized completely and do not have the dangerous side effects, such as a higher risk of cancer, that synthetic and non-bioidentical hormones do.
Views on Hormone Replacement Therapy definitely vary, as we can see. Seeing your doctor and discussing the risks and benefits to you as an individual is therefor recommended. But get the facts, not the opinions.