Bernie Noe, ND

Naturopathic Physician

Take the Natural Route to Better Health

Hormone Replacement Turmoil – What Are Your Options?

Women taking hormone-replacement therapy got more worrisome news last summer.

After years of concern about the long-term health risks, the National Institute of Health (NIH) aborted the largest controlled clinical trial ever conducted on the efficacy of hormone replacement drugs.  The researchers concluded that the health risks of Prempro, a commonly prescribed hormone replacement drug, outweighed its benefits.  After reviewing the data collected thus far, the researchers realized that the women on HRT longer than five years developed 26% more invasive breast cancers, 29% more heart attacks, 41% more strokes and had twice as many blood clots as compared to women on placebo.  Therefore they aborted the study because, on balance, the HRT was benefiting the study participants less than a placebo.

So where do millions of women on hormone replacement therapy go from here?

Prempro for menopause?

Prempro, the medication used in the NIH study, may have been responsible for the disappointing study outcome.  Prempro is commonly prescribed for the relief of menopausal symptoms, and for prevention of osteoporosis and heart disease in women.  Prempro is a combination of Premarin (conjugated estrogens) and Provera (medroxyprogesterone).

Premarin – estrogen from horses

Premarin is a combination of human and horse estrogens.  “Estrogen” is a term used to describe a family of three related hormones found in your body: estriol, estrone, and estradiol.  Premarin is predominantly estrone and a smaller amount of estradiol. It has no estriol.

It’s not known why estriol is missing from Premarin.  Estriol is one of three essential estrogens in your body.  Medical studies indicate estriol reduces symptoms of menopause, and may have a cancer-preventive effect as well as other health benefits.

Premarin also contains a horse estrogen called equilin.  This horse estrogen is extracted from the urine of pregnant mares.  Horse estrogen does not naturally exist in your body, although it has a powerful estrogen-like effect.

Horse estrogens are structurally different from human estrogens; your body is not able to metabolize a horse estrogen the same way a horse does.  Therefore, metabolic problems (“side effects”) are the probable result.

Provera – synthetic progestin

The other drug found in Prempro is Provera, which is a synthetic progestin called medroxyprogesterone acetate.  A progestin is a synthetic substitute that is similar to, but structurally different from progesterone.   Medroxyprogesterone acetate was created in the lab and, like horse estrogen, does not naturally occur in your body.

Only progesterone is the sex hormone that naturally occurs in your body.  When you take Provera, you’re not getting progesterone.  You’re getting an artificial, foreign compound that may cause undesirable metabolic side effects.

There are two reasons to reconsider use of Prempro or similar conventional hormone replacement therapy drugs. First of all, Prempro has a number of side effects, including headache, irritability, restlessness, mood changes, nausea, increase in uterine fibroids, changes in vaginal bleeding, weight changes, changes in sleep patterns, fatigue, upset stomach, bloating, acne, breast tenderness, and changes in sex drive.

Second, according to the NIH study, the overall risks of Prempro outweigh its benefits.  Although Prempro reduces osteoporosis risk and relieves hot flashes, there are less risky products that accomplish the same thing.

What are your hormone replacement options?

Fortunately, you have viable alternatives to horse estrogens and synthetic progestins.

1.  Use “human” hormones.  It is not necessary for you to take a foreign substance like equilin (Premarin) or medroxyprogesterone (Provera).  Estrogens (human, not horse) and progesterone (human, not artificial) are available by prescription from any physician.  These hormones are identical to what’s in your body, and are generally associated with fewer side effects.  Moreover, the relative amounts of progesterone and the three estrogens (estradiol, estrone, and estriol) can be calibrated to your specific needs, based on lab findings and your medical history.

2.  Improve your diet.  Diet profoundly affects menopausal symptoms.  One example is Japanese women who consume a traditional diet.  These women seldom experience unpleasant menopausal symptoms.  In fact, hot flushes are so rare in Japan that there is not even a word in the Japanese language to describe them.  Plus, Japanese women have a much lower rate of breast cancer.  What’s their secret?   It’s not because they all take Premarin or Provera.  It appears to be the soy and other foods they eat.

3.  Modify your lifestyle and environment.  How you behave can reduce menopausal problems, as well as reduce your risk of osteoporosis and heart disease.  One obvious example is exercise.  Regular exercise has been proven to help prevent bone loss and cardiovascular disease.  Plus, all of its “side effects” are good ones.  You feel better and look better.  Stress management, low alcohol consumption, and smoking cessation can help too.

4.  Consider special herbs and supplements.  There are vitamins, minerals and herbs that can help you to better manage your menopausal transition, as well as protect you from osteoporosis and heart disease.  They also tonify and nourish your reproductive and glandular systems.  One herbal example you may be familiar with is black cohosh, a plant with estrogen-like properties.  Since 1956, over 1.5 million women in Germany have used an extract of black cohosh to treat menopausal complaints with good success and without side effects.

5.  Make sure your liver is healthy.  One of the primary functions of your liver is to metabolize or detoxify hormones and other substances that accumulate in your body, and to prepare them for removal.  This function is important for maintaining proper hormonal balance; if your liver did not do this job, hormones would simply build up in your body until they became quite toxic, creating serious symptoms.

What about osteoporosis?

You may be taking Prempro because your M.D. told you it was necessary to prevent osteoporosis.  In fact, the NIH study reported that women taking Prempro had slightly fewer hip fractures than women on placebo.  But this does not mean that you must take Prempro or similar product to protect yourself from bone loss.

In a study performed by John Lee, M.D., natural progesterone was found to reverse bone loss.  Dr. Lee, who has pioneered the use of natural progesterone, found that his patients experienced a 5-10% increase in bone mineral density after one year of supplementation.  At the end of the three-year study, the average increase in bone density was 15.4%, and none of the women experienced a loss of bone density.

Also keep in mind there are millions of women all over the world who never develop osteoporosis and have never taken Prempro, Premarin or Provera.  The reason is that osteoporosis is a complicated disorder involving many factors, including your overall hormonal patterns, genetic predisposition, ethnicity, diet, lifestyle and other factors.

The best way to protect yourself from developing osteoporosis is to work on all of your controllable risk factors.

What should you do about HRT?

There’s no “right” or “wrong” answer to hormone replacement therapy.  There is only the “best” answer, according to your specific health needs and goals.  Consult with a naturopathic physician who is knowledgeable about all the alternatives to conventional hormone replacement therapy