Hormone replacement therapy

Findings on HRT since the Women’s Health Initiative — an individual approach is best

by Marcelle Pick, OB/GYN NP

• The Women’s Health Initiative results — then and now
• New evidence on the use of hormones for menopause
• Risks and benefits of HRT — individuality is central
• Phytotherapy: a safe and effective alternative
• Your options for menopause symptom relief

If you’ve been keeping up with the news, you’re probably aware of the recent questions about risks and benefits of hormone replacement therapy (HRT). These reports, along with new scientific evidence, are leading some women and their healthcare practitioners to reconsider the 2002 mandate to stay off of HRT. Both at the clinic and in our Personal Program, I hear this question again and again: “What’s changed since the negative results of the Women’s Health Initiative?”

I’m happy to say that researchers have been busy over the past few years, and their findings give the medical world new perspective on the use of HRT for menopause symptoms. The answers we now have are similar to what Women to Women has been telling women all along — the decision to go on hormone replacement therapy is individual, and the risks, benefits, and side effects differ depending on the individual.

I have seen some menopausal women do well on conventional HRT (though we don’t keep them on it if we can get them off), and others who soar following a gentler approach, like bioidentical HRT or phytotherapy. In the end, you can take comfort in the fact that there are several options for menopause symptoms — and we’re here to help you understand them.

The Women’s Health Initiative results — then and now

Time has given researchers more perspective on the results that came out in 2002, when women were warned that hormone replacement therapy leads to higher risks for breast cancer, cardiovascular events, blood clots, cognitive decline, and more. An extensive collection of data has been scrutinized and published. Though we still don’t know everything there is to know about the risks and benefits of HRT, the research is bearing out what I’ve seen in practice for years — timing and individual circumstance are key.

New studies suggest that women under 60 years old and within ten years of menopause can benefit from HRT with much less risk (even with potential benefit) than older women who are more than ten years away from menopause. The majority of the women enrolled in the WHI study were older and much past menopause.

The most recent evidence on the use of hormones for menopause

Here’s an overview of how HRT may affect certain health issues:

Although the new research is promising, one limitation is that much of it still looks only at synthetic progesterones and equine estrogens (estrogens derived from a pregnant horse). These hormone forms are molecularly different from the hormones we make in our bodies, so drug companies can patent them.

Bioidentical hormones, on the other hand — those that have the same molecular structure as those made in our bodies — are becoming more popular. We’ve always used bioidentical hormones at the Women to Women Clinic because we feel they are gentler on the system than synthetics, and a significant and growing body of research is now bearing this out.

Above all, hormone therapy, synthetic or bioidentical, is not the right choice for every woman — because we all have our own unique set of circumstances. In my practice, I evaluate each HRT case individually at each appointment so women can make informed decisions about starting or continuing bio-HRT on her own terms. And I generally recommend women stay on hormones for fewer than five to seven years.

Risks and benefits of HRT — individuality is central

When I sit down with a woman considering hormone replacement therapy, I always look at her age, proximity to menopause, medical history, and her quality of life. Quality of life is so important, and it’s something conventional practitioners often dismiss if the research shows any kind of risk associated with a given treatment. I have one patient who was diagnosed with breast cancer years ago, and even after the 2002 WHI results came out, she decided she’d never go back to life without bio-HRT. I’ve always respected her position. (Keep in mind, we’re checking her hormone levels yearly — sometimes twice a year — and she’s taking bioidentical HRT.) Each woman, especially when given the information to make an educated decision, has the right to decide what is best for her body.

Researchers tell us that the risk profile for hormone replacement therapy goes down in women under 60, women less than ten years from menopause, and women who don’t have a history of breast cancer, endometrial cancer, or liver disease.

In my opinion, whether or not your hormones are still fluctuating is a more important consideration than whether it’s been less than ten years since you entered menopause. It is safer to introduce HRT when hormones haven’t tapered off yet. This way, your estrogen and progesterone receptors are still active.

Each woman has a different set of circumstances that determine her personal risk, but based on the new evidence and what I’ve experienced in practice, the safety of HRT is enhanced if the following guidelines are met:

• It is given to younger women (under 60), who are close to menopause and whose hormones are still fluctuating.
• The woman does not have a history of breast, ovarian or endometrial cancer, or liver disease.
• The woman uses bioidentical hormones as opposed to synthetic HRT.
• The woman uses transdermal, transvaginal, sublingual, or “melt” forms of HRT instead of pills that need to be swallowed.
• Hormone replacement therapy doesn’t go on for more than five to seven years.

For a broader discussion of risks, read our perspective on the risks of HRT.

Phytotherapy: a safe and effective alternative

Many of the women who were on hormone therapy in the past were instructed by their practitioners to get off of it. Now, as their bodies have gone for some time without replacement hormones, it’s not a great time for these women to start up again — even though their symptoms are still bothering them. A safe and effective option for these women, and for those who just don’t feel comfortable with HRT, is phytotherapy.

Phytotherapy is the use of plants for healing purposes. Herbs like Black Cohosh, Red Clover, Passionflower, and many others are wonderful alternatives for menopause treatment because they work with your endocrine system to ease symptoms instead of the “sledgehammer effect” pharmaceutical drugs often provide.

Herbs offer a gentler approach to menopause symptoms, which means there’s less risk to you than taking a hormone. Though using herbs for menopause may not provide enough relief for some, we’ve found in our clinic that 85% of women can find relief from a plant-based product like our Herbal Equilibrium.

Your options for menopause symptom relief

The media can often make it seem like we have limited options when it comes to our health, but if we’re willing to adopt a more holistic approach, the options are endless. Here are just some of the treatment options we’ve had success with at the clinic and in our Personal Program.

Diet and lifestyle changes. Diet and lifestyle play a large role in exacerbating menopause symptoms. For some women, adding more protein, high-quality fats, and fresh fruits and vegetables, while limiting refined carbohydrates, sugar, gluten, and highly processed foods can make a world of difference. You may also want to consider supplementing with a quality multivitamin like the one we offer in our Personal Program.

Phytotherapy. Soy, Black Cohosh, Red Clover, Ashwagandha, Wild Yam, and other botanicals can offer satisfying relief from menopause symptoms. You can explore our Personal Program’s Herbal Equilibrium, which provides a safe and effective combination of herbs for gentle endocrine support and menopause symptom relief.

Bioidentical HRT (bHRT). Bioidentical HRT consists of hormones made in a lab, primarily from Wild Yam and soy, that are identical to the hormones your own body produces. Bioidentical hormones are available through compounding pharmacies by prescription. For more on how to choose the right bioidentical hormones for you, see our guide to bioHRT options.

Synthetic HRT. Hormone replacement therapy drugs like Premarin and Prempro are the drugs studied in the original Women’s Health Initiative. Premarin is made from the urine of a pregnant horse, while Prempro combines Premarin and a synthetic progestogen. There are also synthetic forms of testosterone. We feel most comfortable with bioidentical HRT, but understand that there are cases where synthetic hormones are a viable choice.

Your body, your choice

Only you can decide what is best for your body. I know from my own personal experience and that of my patients, that menopause can be a confusing time, a time when it’s difficult to make decisions (especially if you haven’t slept well in weeks!). But know that there is an option out there for you — and it’s okay to take your time in deciding. I have some patients who don’t mind enduring the symptoms as long as they know there will be an end to them in good time. Others simply can’t perform their day-to-day activities without some relief from their symptoms. Look inside to make your decision, and don’t ever be afraid to ask questions!

Related to this article:

References & further reading on new findings on the WHI

 

Last Modified Date: 07/23/2012
Principal Author: Marcelle Pick, OB/GYN NP