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Hormone Replacement Therapy – an idea whose time has passed

Posted by Well Being Holistic Pharmacy on

The concept of Hormone Replacement Therapy or HRT (formerly known as Estrogen Replacement Therapy or ERT) was flawed from the outset. It was never able to deliver on the promise of protecting women from the ravages of aging, such as defending against heart disease, avoiding osteoporosis, or keeping them feeling young forever. And yet, even today, Physicians and OB/GYNs continue to prescribe HRT for their patients, exposing them to considerable risk for cancer, heart disease, strokes and blood clots. Despite mounting scientific evidence to the contrary, we are still given the false impression that using hormones from the outside world, whether of synthetic or natural origins, is a sound medical practice. Unless you are living under a rock, you’ve heard about the HRT drug trial that was prematurely terminated. This trial involved over 16,000 women aged 50 to 79 who still had their uteruses. These women were given a combination of conjugated estrogens and progestin, sold under the brand name of “Prempro.” The women taking this drug showed a significant increase in the risk of invasive breast cancer. As soon as the news surfaced, Wyeth, the company that produces the drug, sent their spin-doctors out to perform damage control. They were very quick to point out that the trial involved the combination product, and that no negative conclusions should be drawn about using Premarin, their product that features conjugated estrogen, alone. That strikes me as odd considering that the New England Journal of Medicine (December, 1975) published Wyeth’s findings that Premarin used alone was the cause of a five-to-fourteen-fold increase in endometrial cancer in women. At that time, the spin was that estrogen should not be used unopposed, so we went from ERT to HRT. Now, apparently, it’s back to the ERT. Not to sound like a conspiracy theorist, but if you look at the big business that Hormone Replacement Therapy has become, you might wonder if our medical industry really has women’s best interests at heart. Here are the facts:
  • Premarin was the most-prescribed drug between the years 1992 and 1999.
  • In recent years, Premarin generated more than $2 billion in sales for Wyeth.
There exists an entire “cottage industry” that involves testing women’s bone density, thus supporting the idea that more Premarin needs to be prescribed. Much of the hoopla started in 1966 with the best-selling book, Feminine Forever, written by gynecologist Robert Wilson. Wilson contended that menopause was a disease caused by estrogen deficiency. He said that all the unpleasant symptoms of menopause, including loss of youth and bone density, mood swings, hot flashes, vaginal dryness, etc. were caused by a lack of estrogen. At the time, a drug company happened to have a product (originally approved in 1942 based on the results of one very questionable study) that was not selling very well… Premarin. Suddenly, $1.3 million was donated to set up the “Wilson Foundation,” whose sole purpose was to develop and promote the use of estrogen drugs. The rest of the tale is a sad litany of misinformation, ignorance to the facts, and more tragically, many, many cases of cancer that could have been avoided (did you know that the only known cause of endometrial cancer is unopposed estrogen?). The heartbreaking truth is that we bought into two theories that are flawed at the core. We believed that menopause is a disease and that it is beneficial to make hormonal adjustments from the outside world. Let’s address the replacement of hormones first, which is a really bad idea. Despite what your doctor may tell you, we have only the most rudimentary understanding of how hormones function in our bodies and even more importantly, how those hormones are connected to and affect each other. To picture my point, imagine there is a spider web representing all the hormones manufactured in your body by the various glands (thyroid, adrenal, thymus, pituitary, ovary, pancreas, etc.) and how they are interconnected. Now consider what would happen if we were to pluck one single strand of our spider web… of course, the entire web would reverberate. The same thing happens with the hormones… adding a hormone into the body from the outside is like plucking a strand in this very complicated web. Unfortunately, physicians have a bad habit of looking at our parts as individual and independent, without fully recognizing the “reverberations” that can occur as a result of their actions. The other problem with supplementing hormones from the outside world is the nature of the hormones generally used. Because of business practices that dictate “ownership” of a chemical entity, companies tend to alter the hormones so they can be patented and thus be profitable for the owner. However, making slight chemical alterations in a molecule can vastly change its physical effects in the body. This is never truer than with estrogen and progesterone. Premarin supplies numerous estrogen-like compounds, most of which are not the same estrogens we find in the human female. This is problematic because these different estrogens do not break down as readily as the real stuff, meaning their effect is longer and stronger than what nature intended. As we will discuss later, “estrogen dominance” is a term that every women, regardless of her age, should fully understand. Regarding menopause as a disease is a vantage point that serves the medical and pharmaceutical industries very well. It generates CPT codes for insurance billing purposes and also furthers the idea that drugs are needed to treat this so-called disease. If menopause is really a disease, how did women survive this disease before the 1940’s when the supposed “cure” was created? Would not hundreds of previous generations of women have succumbed to the ravages of this “disease?” Of course, the answer is that menopause is not a disease, it is a natural progression of the hormonal status of a woman as she matures. The truth is that estrogen is designed to do one thing in the human body… prepare it for reproduction. Once a woman hits a certain age, she is no longer designed to have babies and the production of estrogen declines. Notice, I said declines, not stops. Ovaries are not the only place that the body makes estrogen. Estrogen is also produced by fat cells and by adrenal cells. Menopausal symptoms occur when estrogen declines and there is not enough progesterone to balance the remaining estrogen. There are four primary reasons why women in the U.S. have such a hard time going through menopause and all four are related to too much estrogen before menopause, namely, our over-refined diets, lack of exercise, external toxic sources of estrogen (xenoestrogens) and chronic stress. In “advanced” societies, the Standard American Diet (refined carbohydrates, hard fats, and empty calorie foods) serves to as much as double normal estrogen levels. Lack of exercise also contributes to higher estrogen levels. Estrogen-like compounds from plastics, computer chips, PVC pipes, pesticides, soaps, clothing, DDT and other manufactured products look and act like estrogen in a woman’s body. Stress constantly causes the shunting of progesterone into cortisol and other stress hormones, which disrupts the proper balance between estrogen and progesterone. Herein lies the real story… because women from industrialized nations have higher levels of estrogen before menopause; the higher relative drop in estrogen is the true culprit in menopausal symptoms. Women who eat the diets that we eat here, don’t exercise, and are exposed to stress and environmental contaminants experience a 40% drop in estrogen levels after menopause. Women that eat a simpler diet and live a simpler lifestyle experience only a 10% drop. It is the increased change in estrogen drop that causes extreme menopausal symptoms. The best way to avoid menopausal symptoms is to address the issue long before you ever arrive at this junction. Try to eat a more natural diet, focused on less refined and processed foods and more fresh fruits and vegetables. For your own sake, get some exercise! Try not to expose yourself to the nastier chemicals of our world, pesticides and the like. Reduce the stress in your life so that you maintain proper progesterone levels. So… what are the natural ways to treat menopausal symptoms? The first step is to prepare for menopause properly, hopefully way in advance of onset. As we have already discussed, menopausal symptoms occur because there is too much estrogen in the body long before the event. Then, when menopause does begin, there is a bigger relative drop in estrogen, and the crash causes uncomfortable symptoms. Here’s how you can help yourself. A less processed and refined diet tends to lower estrogen levels; so eat more fresh fruits and vegetables and less foods that come in packages. Keeping fat cells at a minimum cuts down on estrogen over-production; so get some exercise and lose the excess weight. Constant stress causes the body to shift progesterone into cortisol and other hormone of stress, thus creating a greater imbalance on the estrogen side; so learn to see the stressful events in your life in a different way, or remove the obvious stress-causing factors. Also, realize that lack of proper sleep profoundly affects the adrenal glands... so make a habit of getting to bed by 10 p.m. and address issues like sleep apnea if needed. Xenoestrogens (estrogen-like compounds present in the environment) from plastics, pesticides and petroleum-derived contaminants, act on the body like souped-up estrogens and thus increase relative estrogen levels in the body. It can be helpful to eat more organic foods and avoid drinking beverages stored in plastic bottles. But what if you are going through menopause now, or are already on HRT? Are there things that you can do to treat the symptoms or replace the hormones? Of course, the answer is… YES! First, if you are already taking HRT and want to stop, realize that a sudden stop would be much like going through menopause again, only probably worse. This would suddenly stop the influx of estrogen into your body… and the estrogen that you’ve been taking is much stronger than what your body would make on its own… so you can expect to be slammed with symptoms. Some of you have already experienced this gem of an experience when you doctor said, “sure… just stop taking them!” The proper way is to gradually reduce the dosage over a period of two-to-three months. At the same time, you can begin to use some of the same supplements I’m about to mention. I also want to point out that whether you have had a “natural” menopause, meaning that your body had the opportunity to allow nature to make the change gradually, or a “medically-induced” menopause, meaning that you had a hysterectomy for whatever reason or your take some sort of medicine that brought it on, makes no difference to your body as to whether or not HRT is a good idea. Both situations are the same… a drop in estrogen to which your body needs to adjust. Usually, my first choice to treat symptoms like hot flashes, night sweats, mood changes, etc., is a product called Estrovera. This is an exclusive, patented extract of a variety of Rhubarb that has been used in Europe for years. The reason I like this product so much is because it is affordable, is very convenient to take, offers amazing safety and is really effective! An alternative is an herb called Black Cohosh. This plant is native to our region and has been used by Native American peoples for centuries. In Europe, where herbal products are more highly respected by the medical community, Black Cohosh is a common recommendation for all of the typical menopausal symptoms. Black Cohosh should be standardized to insure that you are getting a consistent amount of the active ingredient from pill to pill and bottle to bottle. I look for a product that has been standardized to 2.5% triterpene glycosides, which will give 1 mg of the active ingredient for every 40mg of Black Cohosh root extract. Often times you will find other hormone-balancing herbs combined with Black Cohosh, like Dong Quai root, Chasteberry fruit and Licorice root powder. I use a product called Fem Support. The next substance I consider for treating menopausal symptoms are the isoflavones derived from soy and other plants. You can think of isoflavones as very, very weak estrogens. Like other phytoestrogens (estrogen-like compounds that come from plant or food sources), isoflavones can ease menopausal symptoms by bridging the drop from high levels to low levels of estrogen in the body. However, they do so without the same risks inherent in HRT. My favorite source of isoflavone is Red Clover Extract. Typically, I look to give 40mg of Isoflavones from Red Clover twice a day, with food. Red Clover Extract is better tolerated and less likely to cause the allergy concerns often associated with soy products. The fourth tool I use in the fight against menopausal symptoms is progesterone cream. It seems that symptoms improve when there is a certain balance between estrogen and progesterone, and increasing progesterone levels often does the trick. It is also important to note that progesterone is the hormone that regulates the building of bone. There is some compelling data suggesting that increasing progesterone levels can actually help increase bone density, which is the promise that estrogen was supposed to fulfill but failed. Using a topical cream that allows the progesterone to go from the fat cells under the skin directly into the bloodstream seems to be the most effective delivery system. The liver destroys progesterone, and anything that gets absorbed though the digestive track goes to the liver first, then to the rest of the body. I have some concerns about progesterone cream and the various products available over-the-counter. First of all, what you want to look for is pharmaceutical grade, 2% progesterone cream, not wild yam cream. For years the pharmaceutical industry has been using wild yam, or dioscorea, as a root material to synthesize hormones. There are many chemical steps between the yams to the hormones. There is absolutely no evidence that the body has the ability to do the same conversions accomplished in the laboratory… so use actual progesterone! Secondly, as mentioned earlier, the body under stress will use progesterone to make cortisol and other hormones of stress. If a woman is under constant stress (physical, emotional or spiritual), taking progesterone will only increase her ability to make more of the bad hormones. So, before you begin using progesterone cream, carefully evaluate your stress issues and make strides to address them first, the most important of which may be getting to bed by 10 p.m. As is always the case, when it comes to our health and the “fixing” of an apparent problem, there are many different tools to consider. Some of these tools are more likely to cause ill effects than others. Educate yourself about all of the possibilities and I am confident you will choose the best tool for yourself!

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