Hormone Replacement Therapy

In the summer of 2002, prescribing physicians and menopausal hormone users were turned upside down with the media blitz over the publication of the Women’s Health Initiative (WHI) findings.  The study was terminated early due to the apparent risk to women using the synthetic estrogen and progestin combination known as Prempro.  Women’s concerns about hormone use increased sharply following the early termination of the study.  As a result of the wide media coverage it was estimated up to 50 percent of hormone users stopped using them.

Many clinicians, not understanding the methodology of the study, advised their patients to discontinue hormone therapy.  Many of us in alternative medicine and those in support of natural health care rejoiced at the findings with a kind of “I told you so” attitude.  At issue was a long standing mistrust of the pharmaceutical industry and the over zealous prescribing of horse urine estrogen which is clearly not the same hormone that is in a women’s body.

This panic was unfortunate and unnecessary.  The information initially provided was premature and misrepresented.  The study itself was poorly designed.  However, over time and with greater scrutiny the findings yielded more balanced and relevant data.  The potential fallout from the initial interpretation could be millions of women who may never start HRT or who simply stopped taking their hormones prematurely, thus missing the opportunity to receive the benefits from proper prescribing and dosing.

Essentially, what we have learned from all studies to date is that Prempro (Premarin with Provera) is harmful and should not be taken.  The estrogen-only arms of these studies found no significant harm with estrogen alone; only when Provera (medroxyprogesterone) is added to it does it become harmful.  It should be emphasized that in the WHI, the study in the estrogen-only users was not stopped until February 2004 because they had o increase in either breast cancer or heart disease.

I believe it is critical that we understand the potential value of safe and effective hormone therapy, particularly in light of the availability of bioidentical hormones.  All of our body’s hormones are beneficial and provided maintenance of a healthy homeostasis.  It is only when we see a deterioration in our health and well-being.  Restoring these hormones to youthful levels seems appropriate and is supported scientifically.  There are those who would argue that menopause is a natural reflection of normal aging and perhaps we should allow women to simply grin and bare this natural transition into our latter years.  I would suggest that what we experience as menopause primarily in the Western world is not fully natural; rather hormonal change is greatly influenced by our diets, lifestyle, stress and the environment in which we live and work.

Certainly addressing those issues can help and benefit women with menopausal symptoms and long term health risks.  Some natural therapies can also help during the early transition years; acupuncture, herbs, massage and body work and some supplements.  But the reality is we are simply living longer and this is a relatively new phenomenon in the terms of human history.  With our new found longevity has come the risk of a variety of diseases, both physically and mentally.  We see these diseases, along with a variety of hormonal symptoms, picking up momentum as we age and as our hormones decline.  Clearly disease risk and mental decline is tied to declining hormone levels.  The outcome is not certain and surely varies from person to person.  It is why the most important piece of information we received from the WHI study is that “one size does not fie all.”  Hormone replacement therapy must be individually assessed and individually prescribed.  I believe it is important we not toss out the baby with the bath water.

After 30 years of clinical practice and research, I am convinced when the proper regimes and dosage are used there can be many benefits from hormone replacement.