Hormone Replacement Therapy

Hormone replacement therapy: what we know now

by Dixie Mills, MD

For many years, millions of women entering menopause in America were prescribed Premarin or Prempro without much question. Premarin, a mixture of estrogens derived from the urine of a pregnant horse, and Prempro, a combination of horse estrogens and synthetic progesterone, served to replace the human sex hormones that naturally taper off in perimenopausal and menopausal women — primarily estrogen and progesterone.

The rationale for taking synthetic hormones was not only to quell women’s menopausal symptoms, but for their perceived ability to protect women against heart disease, build stronger bones, maintain youthful skin, and support healthy brain function. But when data from the Women’s Health Initiative study were first made public in 2002, both healthcare providers and their female patients were shocked to learn that hormone replacement therapy (HRT) was not as protective — or as safe — as they had once assumed.

The study results suggested that this type of HRT did not protect a woman from getting heart disease, and actually increased her risk of breast cancer, blood clotting and stroke. A reanalysis of this study completed in 2007 further suggested that actual heart disease risk depends on the age at which women begin HRT. But these results remain controversial, as a 2008 reanalysis concluded that hormone therapy is associated with an increased risk of stroke, regardless of when a woman starts the regime.

Sadly, the media and many practitioners often paint all HRT with the same broad stroke. What I mean is that women are so often advised in medical alerts that the risks apply regardless of the type of hormones. The reality is that the reanalysis showed associated risks only for conjugated equine estrogens and synthetic progestins — not bioidentical hormones.

Meanwhile, women continue to come to us every day, utterly confused and even scared about hormone replacement. All along, we’ve been devoted to clearing up the HRT story and setting the record straight for women. For many years we’ve been providing women with alternatives to conventional HRT, including bioidentical hormone replacement therapy (bHRT, or bio-HRT). We don’t know exactly what the risks are for every woman with natural hormones, either, as there haven’t been many large, definitive studies done on natural bioidentical hormone replacement therapy. But from the results of studies that have looked at bioidentical HRT thus far, and from what we’ve seen in our clinical practice in over 20 years of prescribing bHRT to our patients, bHRT does not appear to have the same side effect profile as conventional HRT — particularly transdermal forms.

Bioidentical hormones share the exact same molecular structure with those in our bodies. Unlike conventional or synthetic forms of HRT, they are not patented and sold by pharmaceutical companies — unless they find a way to create a unique delivery system for them. But that’s the main reason why there have been very few large, well-designed studies to evaluate the risks and benefits of bioidentical HRT: historically, it hasn’t been as profitable as synthetic forms. As much as we rely on our clinical experience, we always, always want to see the science to back it up. Clearly, more studies are needed.

Just speaking this truth has a way of stirring up controversy, and some serious efforts have been made to shut down compounded bioidentical HRT as an option for women. We think that’s too bad. Because women deserve to know all of their options and alternatives regarding HRT, to be fully informed of everything we’ve learned to date, and to have ready access to those options when they need them.

What you’ll find in the articles that follow is straightforward information on supporting your hormones and weaning yourself off of conventional hormone replacement therapy, if that’s what you decide is right for you. You’ll find answers to your questions about bHRT and how to decide if that could be a better choice for you, information on how to discuss bioidentical hormones with your practitioner, and our past press releases about hormone replacement therapy in the news. At Women to Women, we know that your body is sacred, and that educating yourself as much as possible will always lead you to better health. After years of experience, here is what we know about replacing hormones. We hope you’ll find the answers you’re looking for.

Our most popular resources on HRT and bioidentical hormones

To access an article, just choose from the list of excerpts below. To find more articles, use the search function below. Don’t see a topic that’s important to you? Let us know.

• Bioidentical hormones: are they right for you?
  With Suzanne Somers’s decision to stay on bioidentical hormones for life, many women want to know if they should consider them as well. Here’s our perspective, after more than 20 years of using bioidentical hormones in practice.
• New findings on HRT since the Women’s Health Initiative — an individual approach is best
  Bioidentical hormone replacement therapy is once again in the news, and Women to Women clarifies the recent science regarding its safety and effectiveness for treating menopausal symptoms.
• Bioidentical hormones — a guide to your options and alternatives
  Women to Women discusses options for women looking for bioidentical hormones, including not only compounded bHRT from compounding pharmacies, but numerous prescription name brand forms that are widely available and easily obtained from regular practitioners and pharmacies.
• Bioidentical hormones — a guide to your options and alternatives
  Women to Women discusses options for women looking for bioidentical hormones, including not only compounded bioHRT from compounding pharmacies, but numerous prescription name brand forms that are widely available and easily obtained from regular practitioners and pharmacies. Includes a table of bioHRT choices.
• What to expect when you’re stopping HRT
  So many women try to get off hormone replacement therapy by going “cold turkey” and wind up suffering. Many give up and decide to go back on as a result of the rebound effect they experience. We’ve helped thousands of women wean themselves from HRT — safely and naturally. Learn what to expect, and allow yourself a smooth transition.
• Talking with your doctor about bioidentical hormones
  Many doctors and healthcare practitioners don’t prescribe bioidentical hormones, primarily because they aren’t familiar with or don’t have time for the individualized approach they require. Here’s some practical advice on discussing bHRT with your doctor, so you can satisfy your needs without a struggle.
• FAQ’s on bioidentical hormones and other forms of HRT
  There are so many questions out there about bioidentical hormones and hormone replacement therapy. Learn the distinctions between synthetic and bioidentical forms and how to decide what feels right for you from experienced women’s health practitioners.
• Hormone replacement therapy (HRT) — a history behind HRT and new alternatives, such as bioidentical hormones
  Here’s a brief history of the development of hormone replacement therapy by the pharmaceutical industry, and why so many women were abruptly taken off of it after the release of the 2002 Women’s Health Initiative study results. Learn more about how conventional forms of HRT compare to bioidentical hormone replacement therapy.
• Our perspective on the risks of HRT
  When the Women’s Health Initiative results first came out, both women and their healthcare practitioners were suddenly fearful of the risks associated with hormone replacement therapy. But are these fears warranted? Here’s a balanced look at the risks of HRT.
• Press release - bioidentical hormones for menopause symptoms stirs up needless fear
  An October 2009 story on bioidentical hormones by the Associated Press only confuses the subject more.
• Press release on 2008 FDA news about bHRT
  Bioidentical hormones are getting more press recently, after years of being on the sidelines. Unfortunately, the reporting only confuses matters more for women! Hear about the recent news concerning the FDA and bHRT, and why the implications matter more than ever now.
• Press release on the 2007 WHI reanalysis
  The Women’s Health initiative study showed dangerous risks associated with conventional HRT and altered the way millions of women were being treated for their menopause symptoms. A reanalysis of the study doesn’t change much, despite the media’s claims about a reversal of findings.
• 2006 Press release on Suzanne Somers and bioidentical HRT
  If you watched Suzanne Somers on the Larry King show, you may have been confused by the heated debate surrounding bioidentical hormones. Here’s a rational look at some of the elements and motivations behind the controversy.

 

Original Publication Date: 9/02/2005
Last Modified: 02/16/2010
Principal Author: Dixie Mills, MD