Hormone Replacement Turmoil—What Are Your Options?
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
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 &endash; 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 &endash; 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
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
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. Another option is Estrovera®, an herbal
extract of rhubarb, which is typically very effective at relieving
menopausal hot flashes.
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 and to take vitamins
and minerals such as strontium and vitamins K and D.
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.
Naturopathic doctors are physician
experts in treating the underlying cause of disease and using natural
medicines to help people get and stay well. To see a naturopathic
doctor for help with addressing menopausal complaints and in managing
natural, bio-identical hormone therapy, please make a selection below.