The debate about the benefits versus the risks of hormone replacement therapy (HRT) has raged for a decade, since data from the Women’s Health Initiative was first published in July, 2002. Now, a series of articles published in the June 2012 issue of Climacteric, the journal of the International Menopause Society, have concluded that the benefits of hormone replacement therapy outweigh the risks for women who begin HRT near menopause.

The Women’s Health Initiative (WHI), a large government-sponsored trial, studied only conjugated equine estrogens (“CEE”, derived from the urine of pregnant horses) and the progestin medroxyprogesterone acetate (“MPA”, a synthetic derivative of the natural hormone progesterone). CEE and MPA are non-bio-identical hormones—they are not the same as hormones made by the human body. Also, the average woman in the study was 12 years past menopause when hormone therapy was initiated.

Unfortunately, in response to the WHI, the lay media and even medical professionals extrapolated the WHI results to include all forms of estrogen and progesterone. Headlines incited panic, and frightened women were advised to discontinue all forms of HRT. Use of manufactured hormones dropped by about 50%, drug companies lost billions of dollars, and women began to seek alternate therapies to relieve the life-changing symptoms that many women experience pre, post, and during menopause.

Since the WHI, hundreds of articles have discussed the risks of using “estrogen” without stating that the study dealt exclusively with CEE. And, reviews still continue to use the terms “progestin” and “progesterone” interchangeably, while in fact, the two hormones are very different. Progestin and progesterone have both been shown to decrease the risk of endometrial hyperplasia, which is the medical term for overgrowth of the lining of the uterus, a precursor to uterine cancer. This is the reason why a progestin or progesterone is prescribed concurrently with estrogen therapy in women who have a uterus. However, there are multiple other ways that women can benefit from progesterone therapy. Many of the body’s organs and tissues – such as the brain, heart and bones – have progesterone receptors, and when progesterone levels decline as a result of aging, the body suffers: women experience memory loss, cardiovascular disease, and bone fractures. These are problems that synthetic derivatives of progesterone, i.e. progestins, do not help.

When hormone therapy is needed, we recommend the use of bio-identical hormones: estrogens such as estradiol, progesterone, testosterone or DHEA, and natural thyroid hormones. Bio-identical hormones have been prescribed in Europe since the 1950s and have been widely used in North America since the 1990s, and many studies have described the benefits and advantages of bio-identical hormones. For example, a study conducted at three prestigious locations, including the Yale University School of Medicine, concluded that natural progesterone, but not medroxyprogesterone acetate (MPA), enhances estrogen’s beneficial effects on heart muscle in postmenopausal women. At Oregon Health Sciences University and USC School of Medicine, synthetic MPA was compared with natural progesterone in primate studies. MPA was shown to constrict coronary arteries, causing vasospasm and heart attack, while natural progesterone dilated coronary arteries. Progesterone plus estradiol protected against vasospasm, but MPA plus estradiol did not. In addition, the group treated with bio-identical estrogen had 50% less arterial plaque formation than the control group. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial, a 3-year multicenter, randomized, double-blind, placebo-controlled study of 875 healthy postmenopausal women, confirmed that synthetic progestins partially negate the beneficial effects on cholesterol levels that result from taking estrogen. Natural progesterone, on the other hand, maintains all the benefits of estrogen on cholesterol without any of the side effects associated with synthetic progestins.

Researchers at Keck School of Medicine, University of Southern California, report that cumulative data supports a “window-of-opportunity” for maximal reduction of coronary heart disease and overall mortality, with minimization of risks when HRT is initiated before 60 years of age and/or within 10 years of menopause and continued for 6 years or more. Results showed a substantial increase in quality of life (adjusted for age) over a 5 to 30-year period in women who initiated HRT in close proximity to menopause, supporting HRT as a highly cost-effective strategy for improving quality of life in menopausal and post-menopausal women.

For optimal wellness throughout all of life’s stages, we also recommend a healthy lifestyle, natural organic foods free of additives like high fructose corn syrup, and regular exercise. In addition, professional-quality adaptogens and herbal and nutritional supplements can offer many benefits.

Contact our professional staff today to discuss your unique needs, and begin your journey to optimal wellness. 

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