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.

 

Last Modified Date: 05/25/2011
Principal Author: Dixie Mills, MD