Should You Take Hormones?
Julian Whitaker, MD
Lois, a 50-year-old patient of mine, came to see me in a state of frustration and confusion. She was having severe menopausal symptoms and, and her gynecologist had written her a prescription for Premarin and Provera, the best-selling hormone replacement drugs. But Lois had heard so much about the negative aspects of hormone replacement therapy (HRT) that she just didn’t know what to do.
Given all the conflicting information, it’s no wonder Lois and so many other women are confused about HRT. I am convinced that much of the problem lies squarely in the hands of the large pharmaceutical companies, who for years have touted synthetic and unnatural hormones such as Premarin and Provera as God’s gift to womankind. Now that research has revealed problems with these drugs, women are more wary than ever about hormone replacement therapy.
The Pros, the Cons, and the Unknowns
Scores of studies have shown that HRT relieves menopausal symptoms such as hot flashes and sleep disturbances. However, there is a definite downside to synthetic hormones, as shown in the 2002 Women’s Health Initiative Study. Rather than protecting against heart disease, it may actually increase risk. And although the study did demonstrate protection against hip and other bone fractures, it was linked to an increased risk of ovarian and breast cancer and a slight increase in dementia.
Based on this and other studies, the American College of Cardiology now advises against initiating hormone replacement therapy for women with a history of heart disease, and the FDA requires this warning on estrogen-progestin combination products: “Women with a history of coronary artery disease may have an increased risk of serious cardiac events during the first year of treatment with estrogen/progestin treatment.”
Before we throw the baby out with the bathwater, let’s sort this all out. Much of the problem, in my opinion (and that of the FDA, judging by the above label warning), lies with the type of HRT used. This is one case where science has not improved on Mother Nature.
Progestin Is Not Progesterone
Progestin is adulterated progesterone. To make Provera (medroxyprogesterone acetate), the most popular progestin, the drug company starts with human-identical progesterone, then alters its molecular structure. Now why would anyone want to alter a hormone produced by every woman on the planet? To “improve” upon it? No. I believe the sole incentive for tampering with a natural substance is to create a product that can be patented. The patent is the financial force that drives the development of new drugs, as it enables pharmaceutical firms to charge exorbitant prices for their products.
Progestin may be good news for the drug companies, but it is bad news for women. It actually “undoes” many of the beneficial effects of estrogen: decreases levels of protective HDL cholesterol, increases insulin resistance, and inhibits the responsiveness of the arteries by 50 percent, according to several studies!
Compare this to natural, human-identical progesterone, which has none of the negative actions of progestins. Italian researchers treated postmenopausal women with estrogen for four weeks, then added natural progesterone or progestin to their hormonal regimen. During each phase of the study the women underwent exercise stress testing to see how long they could exercise before exhibiting signs of inadequate blood flow to the heart.
While taking estrogen alone, the women’s exercise time on the stress test increased, compared to their baseline tests. When natural progesterone was added, treadmill performance further improved. However, during the study segment when the women were taking progestin, exercise performance declined dramatically.
Horse Hormones? I Don’t Think So
The leading estrogen replacement drug, Premarin (conjugated estrogens), isn’t entirely innocent, either. It is a combination of horse hormones and estrone, a type of estrogen that has been implicated in hormone-mediated cancers, including breast cancer.
Estrone is only one of three major forms of estrogen that are produced by a woman’s body. The other two types are estradiol, which is secreted by the ovaries and is the most active form, and estriol, a weak but extremely benign form of estrogen. It would make sense to prescribe natural, human-identical versions of these safe and effective forms of estrogen rather than a drug derived from the urine of pregnant mares—and, in fact, this is what we do at the Whitaker Wellness Institute.
The estrogen preparation we prescribe for our patients is called bi-estrogen. It is 80 percent *estriol and 20 percent estradiol. I cannot say for certain that this human-identical estrogen formulation is safer than the conjugated horse estrogens; there have been no head-to-head studies. However, I can say that the stronger estrogens do stimulate proliferation of breast cells, which may contribute to cancer, while estriol actually protects against estrogen-stimulated breast cell replication.
HRT: Making the Choice
A woman’s decision to start hormone replacement therapy is a personal decision, and she must take into consideration a broad range of factors. Our physicians at Whitaker Wellness discuss with each woman her medical history, risk factors, and personal preferences, tell her the pros and cons not only of hormone replacement therapy in general but of the various types of estrogen and progesterone, then leave the decision up to her.
By the way, Lois, the patient I told you about earlier, threw away her prescription for Premarin and Provera and chose to begin natural HRT. She reports that she is very satisfied with her regimen.
*NOTE: In 2008, at the behest of a pharmaceutical company, the FDA began threatening physicians and compounding pharmacists that use estriol. To read more about this heinous action and how the FDA is functioning as little more than a puppet of Big Pharma, click here.
- If you’d like to learn more about seeing a doctor at the Whitaker Wellness Institute to discuss natural hormone replacement therapy, call (866) 944-8253 or click here.
- Manson, JE et al. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med. 2003 Aug 7;349(6):523-34.
- Anderson, GL et al. Effects of estrogen plus progestin on gynecologic cancers and associated diagnostic procedures: the Women’s Health Initiative randomized trial.JAMA. 2003 Oct 1;290(13):1739-48.
- Chlebowski RT, et al. Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women’s Health Initiative Randomized Trial. JAMA. 2003 Jun 25;289(24):3243-53.
- Rapp, SR et al. Effect of estrogen plus progestin on global cognitive function in postmenopausal women: the Women’s Health Initiative Memory Study: a randomized controlled trial. JAMA. 2003 May 28;289(20):2663-72.
- Cauley, JA, et al. Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women’s Health Initiative randomized trial. JAMA. 2003 Oct 1;290(13):1729-38.
Modified from Health & Healing with permission from Healthy Directions, LLC. Copyright 2004. Photocopying, reproduction, or quotation strictly prohibited without written permission from the publisher. To subscribe to Health & Healing, click here.