In recent years, hormone replacement therapy (HRT) has been offered as an option to help treat menopause-related discomfort and prevent long-term conditions common in post-menopausal women. Evidence shows, however, that risks of HRT outweigh its benefits. Talk to your patients about HRT.
• During menopause, which occurs between the ages of 45 and 55, the ovaries produce lower levels of the sex hormones estrogen and progesterone. As a result, many women experience hot flashes, night sweats, sleeplessness, mood swings, and vaginal dryness. Bone loss, angina and heart attacks are also more common in women after menopause.
• HRT, which provides relief for menopausal symptoms, usually involves treatment with estrogen or estrogen in combination with progesterone. The therapy can double hormone levels in post-menopausal women and decrease the risk of hip and spine fractures and of colon cancer.
• Recent evidence indicates, however, that the overall risks of estrogen plus progestin therapy outweigh the benefits,1 significantly increasing the likelihood of dementia, blood clots, stroke, heart disease and breast2 and ovarian cancer.3 HRT has not been proven beneficial in older women with pre-existing heart disease. Additionally, it doesn’t appear to affect post-menopausal women’s general health, vitality, mental health, or sexual satisfaction.2
• A recent study has also connected a 6.7-percent decline in the rate of new breast cancer cases in post-menopausal women in 2003 to a national decline in the use of HRT (from 61 million prescriptions of Premarin(R) and Prempro(TM) in 2001 to 21 million in 2004).4
• While hormone therapy can have short-term benefits, many menopause-related symptoms will eventually disappear, and many require no treatment. A healthful diet and lifestyle helps to decrease the risk of bone loss and cardiovascular problems. Calcium and vitamin D supplements can help prevent osteoporosis5 and their effects on hip, spine, and wrist fractures, as well as on colon cancer are being tested.
• Soy-based foods and some nutritional supplements can also be helpful in reducing the symptoms of menopause. These include evening primrose, black cohosh, Dong quai, vitamin E, and vitamin B complex. Their benefits and risks are not definitively proven, but are being researched.5
References
1. JAMA 2002;288:321-333.
2. NEJM 2003;348:1839-54.
3. Lancet, 2007 Apr 19.
4. NEJM 2007 Apr 19;356(16).
5. Amer Acac Nurse Pract 1999;11(5):187-98.
1 comment:
The use of synthetic female hormones will go down in history as one of the worst failed medical experiments of all time. The most widely prescribed estrogen called Premarin doesn't come from humans. It comes from pregnant horse urine. The most widely prescribed synthetic progesterone called Provera is a chemical which is not normally found in the human body or anywhere else in the animal or plant kingdom.
After 30 years in medical practice, I have been astounded by the fact that our medical system uses these synthetic hormones. However, if you consider the financial implications, this is not surprising. Current law prohibits patent protection for the manufacture of natural substances like human estrogen and human progesterone. However, the Synthetic versions can be patented and therefore profitable.
The NIH Women's Health Initiative WHI study used Premarin and Provera, and was halted early because of increased risk of breast cancer and heart disease from these synthetic hormones.
Natural Bio-Identical Hormones, on the other hand, are safe and effective. These are the ones found naturally in the human body, and we know from the French Cohort Study, there is NO increased risk of breast cancer, and a recent NEJM coronary calcification study shows that bio-identicals are protective of heart disease.
For more info see:
Balancing your Hormones Safely
Jeffrey Dach MD
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