Bioidentical Hormone Health

AnnA Rushton
July 25, 2010

Cancer Research UK has highlighted the disturbing fact that the number of cases of cancer of the womb in the UK has reached a 30-year high. Their recently published study has revealed that more than 7,530 women develop the disease every year.

Hormonal changes in overweight or obese women could be responsible for the high number of cases, as could a drop in the number of pregnancies, experts at the charity suggested. However the major well-known risk factors are all connected to the levels of different hormones in the body and their overall balance.

The charity noted that  “When levels of oestrogen in your body are higher and progesterone is lower, it still lets the cells in the womb grow, and that happening over a long period of time can lead to an increase of womb cancer.” Sounds like a fair description of oestrogen dominance to me, and the results of allowing unopposed oestrogen without the balancing effect of natural progesterone.

It is sad, but not surprising, that oestrogen dominance is still not given enough serious credence by the medical profession as their drive to prescribe HRT rather than any natural alternatives seems undiminished.

I had a conversation recently with a lady who was interested in natural HRT but was told that it was ‘all nonsense’ by her doctor. The lady wanted to change her HRT for something with fewer side effects but the nil side effects option of replacing her HRT with natural hormones was certainly not offered to her.

It’s no wonder that so many women vote with their feet and switch to natural alternatives themselves.

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Be Well Philly

Daniel A. Monti, director of the Myrna Brind Center of Integrative Medicine at Thomas Jefferson University Hospital, answers five confusing questions

July 19, 2010

If you conduct an internet search for Hormone Replacement Therapy (HRT), you’ll see reams of information that is supposedly intended to help women determine if HRT is “right” for them. From medical journals and health care institutions, to the government and even Oprah, everyone seems to have an opinion on HRT. But there are so many inconsistencies and biased statements that it is a challenge for the average woman to make an informed decision. The answers to the following five questions are what I think every woman should know prior to discussing the matter further with her physician.

1) What is Hormone Replacement Therapy (HRT) and what does it treat?

Let’s start with the basics. First, although there are numerous hormones in the body, HRT generally refers to replenishing the ones made by the sex glands (ovaries for women; testes for men), which include estrogen, progesterone, and testosterone. The production of these hormones declines with age, which can create symptoms. The decline starts around age 40 and can continue for up to a couple of decades, culminating in menopause. Not every woman struggles with menopausal or perimenopausal symptoms, but those who do often complain of the following:

• Hot flashes
• Poor sleep patterns
• Diminished Libido
• Mood fluctuations
• Low energy

HRT has been shown to dramatically improve these symptoms. In addition, women can notice diminished bone density – osteopenia and osteoporosis – which also can be improved with HRT.

2) Why is there controversy about HRT?

By the year 2000, over 10 million U.S. women were taking synthetic estrogen – most often Premarin, or Premarin in combination with progestin (a synthetic form of progesterone), under the brand name PREMPRO.

In 2002, the first large-scale study of HRT, called the “Women’s Health Initiative (WHI)”, found that women who were taking PREMPRO had an increased risk for heart disease, blood clots, breast cancer and stroke. The results were so overwhelming that the study was prematurely terminated. A second study, the Heart Estrogen Progestin Replacement Study (HERS Study), showed that women who had a previous cardiovascular event had increased risk of having a second one if they were taking synthetic HRT.

Results of these two studies threw the HRT industry into a tailspin, causing millions of women to be taken abruptly off of Premarin and PREMPRO with nowhere to turn. Fortunately, there are now several other options available for the informed patient.

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Bioidentical Hormone Health

United Kingdom

by AnnA Rushton

July 12, 2010

A survey carried out through Yours.co.uk in association with Phyto Soya UK has revealed that 80% of menopausal women in the UK are not being offered alternatives to HRT. Frankly, I’m surprised that 20% are being offered alternatives.

It seems that just under half of all women in the UK who went to the doctor with symptoms of menopause were prescribed HRT and that certainly confirms my own observation that you are as likely to be offered HRT as not, whatever your symptoms.

At that first consultation, nearly 60% of women felt that they were not given enough information on how to cope with the menopause or advice on any alternative treatment.

What doctors do not seem to have really taken on board yet is that a staggering 50% of women who are prescribed HRT will abandon it because of fears of its links to cancer, particularly breast cancer.

The general response, if a woman is not well suited to the HRT she is taking, is to switch prescriptions and this can be done several times until either a particular formulation is found which has the least side-effects or the woman herself decides to seek an alternative.

Dr John Lee, a pioneer of natural progesterone use for menopause and hormonal problems, always said that it was going to be down to the women to enforce change and he certainly seems to be right if these figures are anything to go by.

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June 8, 2010

Women who want to use hormone replacement therapy may be less likely to have a stroke if they use low-dose patches instead of pills, Canadian researchers reported on Thursday.

Their study of British women showed that those who used estrogen patches to control symptoms of menopause did not have any higher risk of stroke than women who did not use HRT.

The study, published in the British Medical Journal, adds to a very slowly growing body of evidence that could rehabilitate the use of HRT, which plummeted in 2002 after the publication of the Women’s Health Initiative study, which found an increased risk of ovarian cancer, breast cancer, strokes and other health problems from hormone therapy.

Sales of U.S. market leader Wyeth’s combined estrogen-progestin therapy Prempro have fallen by about 50 percent since 2001 to around $1 billion a year. Wyeth is now owned by Pfizer.

But many experts who studied HRT said there was some evidence that if women took a lower dose and if they took HRT by means other than a pill, the risks might not be as high.

Samy Suissa of McGill University in Montreal and colleagues used Britain’s national medical database to pick out 15,700 women over 50 who had strokes and nearly 60,000 who had not.

Women who had used low-dose transdermal patches to get their HRT had almost precisely the same risk of stroke — very slightly less, in fact — than women who used no HRT.

“I think that these are promising findings,” said Dr. JoAnn Manson of Brigham and Women’s Hospital and Harvard Medical School in Boston, who helped lead the Women’s Health Initiative and who was not involved in Suissa’s study.

Suissa’s team found that 7.7 percent of stroke patients had been given a prescription for some form of HRT within the previous year of their stroke. And 6.9 percent of women who did not have a stroke got some form of HRT.

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News Author: Laurie Barclay, MD
CME Author: Penny Murata, MD

Authors and Disclosures

CME/CE Released: 04/08/2010; Valid for credit through 04/08/2011

April 8, 2010 — Women must be informed of the potential benefits and risks of all treatment options for menopausal symptoms and concerns and should receive individualized care, according to a review of the role of perimenopausal hormone therapy published in the April issue of Obstetrics & Gynecology.

“With the first publication of the results of the Women’s Health Initiative (WHI) trial in 2002, the use of HT [hormone therapy] declined dramatically,” write Jan L. Shifren, MD, and Isaac Schiff, MD, from Harvard Medical School and Massachusetts General Hospital in Boston. “Major health concerns of menopausal women include vasomotor symptoms, urogenital atrophy, osteoporosis, cardiovascular disease, cancer, cognition, and mood…. Given recent findings, specifically regarding the effect of the timing of HT initiation on coronary heart disease [CHD] risk, it seems appropriate to reassess the clinician’s approach to menopause in the wake of the recent reanalysis of the WHI.”

Many therapeutic options are currently available for management of quality of life and health concerns in menopausal women. Treatment of vasomotor hot flushes and associated symptoms is the main indication for hormone therapy, which is still the most effective treatment of these symptoms and is currently the only US Food and Drug Administration–approved option. For healthy women with troublesome vasomotor symptoms who begin hormone therapy at the time of menopause, the benefits of hormone therapy generally outweigh the risks.

However, hormone therapy is associated with a heightened risk for coronary heart disease. Based on recent analyses, this higher risk is attributable primarily to older women and to those who reached menopause several years previously. Hormone therapy should not be used to prevent heart disease, based on these analyses. However, this evidence does offer reassurance that hormone therapy can be used safely in otherwise healthy women at the menopausal transition to manage hot flushes and night sweats.

Although hormone therapy may help prevent and treat osteoporosis, it is seldom used solely for this indication alone, particularly if other effective options are well tolerated.

Short-term treatment with hormone therapy is preferred to long-term treatment, in part because of the increased risk for breast cancer associated with extended use. The lowest effective estrogen dose should be given for the shortest duration required because risks for hormone therapy increase with advancing age, time since menopause, and duration of use.

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Laurie Barclay, MD

April 8, 2010 — Women must be informed of the potential benefits and risks of all treatment options for menopausal symptoms and concerns and should receive individualized care, according to a review of the role of perimenopausal hormone therapy published in the April issue of Obstetrics & Gynecology.

“With the first publication of the results of the Women’s Health Initiative (WHI) trial in 2002, the use of HT [hormone therapy] declined dramatically,” write Jan L. Shifren, MD, and Isaac Schiff, MD, from Harvard Medical School and Massachusetts General Hospital in Boston. “Major health concerns of menopausal women include vasomotor symptoms, urogenital atrophy, osteoporosis, cardiovascular disease, cancer, cognition, and mood…. Given recent findings, specifically regarding the effect of the timing of HT initiation on coronary heart disease [CHD] risk, it seems appropriate to reassess the clinician’s approach to menopause in the wake of the recent reanalysis of the WHI.”

Many therapeutic options are currently available for management of quality of life and health concerns in menopausal women. Treatment of vasomotor hot flushes and associated symptoms is the main indication for hormone therapy, which is still the most effective treatment of these symptoms and is currently the only US Food and Drug Administration–approved option. For healthy women with troublesome vasomotor symptoms who begin hormone therapy at the time of menopause, the benefits of hormone therapy generally outweigh the risks.

However, hormone therapy is associated with a heightened risk for coronary heart disease. Based on recent analyses, this higher risk is attributable primarily to older women and to those who reached menopause several years previously. Hormone therapy should not be used to prevent heart disease, based on these analyses. However, this evidence does offer reassurance that hormone therapy can be used safely in otherwise healthy women at the menopausal transition to manage hot flushes and night sweats.

Although hormone therapy may help prevent and treat osteoporosis, it is seldom used solely for this indication alone, particularly if other effective options are well tolerated.

Short-term treatment with hormone therapy is preferred to long-term treatment, in part because of the increased risk for breast cancer associated with extended use. The lowest effective estrogen dose should be given for the shortest duration required because risks for hormone therapy increase with advancing age, time since menopause, and duration of use.

Low-dose, local estrogen therapy is recommended vs systemic hormone therapy when only vaginal symptoms are present.

Alternatives to hormone therapy should be recommended for women with or at increased risk for disorders that are contraindications to hormone therapy use. These include breast or endometrial cancer, cardiovascular disease, thromboembolic disorders, and active hepatic or gallbladder disease.

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Make sure you read all of the data on this.  HRT does not have more benefits than risks except for specific and extreme cases.  Correcting hormone imbalances with bioidentical hormones is much more effective and with less health risks.

March 11, 2010, 4:44AM

Women who take two-hormone replacement drugs for years may increase their risk of lung cancer, according to a study of more than 36,000 Washington women aged 50 to 76.

Scientists from Oregon and Washington tracked the Seattle-area women for six years, recording how many of the women used drugs to replace estrogen and progesterone that decline during menopause. They also looked at how many of the women developed lung cancer. Progesterone/estrogen pills have been linked to other cancers, raising the risk for breast cancer, for instance, while lowering the risk of colon cancer.

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On our sandy peninsula, groundwater issues are ever more controversial concerns about nitrogen in the bays, phosphorus in the ponds and costs to residents, but researchers at Silent Spring Institute in Newton are peering into another corner of the kerfluffle.

For decades people have been flushing hormones and drugs, which don’t break down particularly fast, into not only the ponds but the drinking water supply.

David Dow, head of the Cape and Islands Sierra Club, helped organize a forum on emerging contaminants in the groundwater, that was held last week in Falmouth.

“It was to initiate a dialogue and address concerns as we upgrade the wastewater structure on Cape Cod,” he explained. “The Silent Spring Institute and the Sierra Club both feel we should do something about endocrine disrupters, pharmaceutical compounds and personal care products.”

Hormones such as androstenedione, estrone, progesterone and the drugs ibuprofen, meprobamate, trimethoprim, pentoxifylline, suylfamethoxazole and carbamazepine have been found in Cape Cod ponds by SSI. Pentoxifylline, for example, is a blood thinner, trimethoprim and sulfamethoxazole are antibiotics, carbamazepine an anticonvulsant.

“The first thing people need to do,” Dow said, “is follow the suggestions of Silent Spring Institute in ways that can reduce their use and for pharmaceuticals we should also have a collection project just as we do for household toxins – instead of people pouring (unused drugs) down the toilet.”

It is possible also to remove them from drinking water when the water is treated.
But hormones are natural and drugs are good, so advertisements tell us.

“The health effects of exposure to low levels aren’t known at this point,” Dr. Laurel Schaider of SSI explained. “But pharmaceuticals are designed to be active at low levels and there are concerns; an infant’s system is more sensitive. And then there is the additional effect of mixtures.”

SSI has looked at six different ponds on Cape Cod, considering them as a lens into the groundwater and is planning to sample the drinking water in different towns.

“Silent Spring has been doing work on the water on Cape for over a decade,” Schaider said. “We’ve tested groundwater, drinking water and detected endocrine disrupters and pharmaceuticals in all kinds of water.”

The levels were greater in the ponds surrounded by more people. They also discovered them in groundwater downstream from a leach field in Sandwich.

“It showed the chemicals being discharged from the system traveled in the groundwater and didn’t degrade much,” noted SSI’s head scientist Ruthann Rudel. “The Cape has a higher vulnerability in the water supply because of the sandy soil, rapid groundwater flow and low organic content. The Cape has fairly close development to have septic systems as the primary way dealing with wastewater.”

“The health effects have been better studied in fish and other organisms,” Schaider noted.
“Male fish have become feminized and produced eggs due to low levels of hormones.”

The institute originally was investigating elevated (20 percent higher) breast cancer rates on Cape Cod that are not explained by the older population.

“Endocrine disrupters that mimic estrogen may play a role in breast cancer,” Schaider said, “because we know lifetime exposure to estrogens in the body can play a role in getting breast cancer.”

“When the frequency of women taking hormone replacement therapy has gone down, breast cancer incidence goes down,” Rudel added.

The new project will look at public water supplies in Buzzards Bay, Dennis, Falmouth, Chatham, Brewster and four districts in Barnstable.

“We’ll be getting raw untreated water from the wells,” Schaider said. “We’ll have results sometime in the spring.”

Hormones can affect sexual development, fertility and possibly cancer rates in other hormonally sensitive organs, such as the prostrate gland.

“All the discussions about our groundwater focus on nitrogen. We thought other chemicals should be part of the discussion,” Schaider concluded.

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Posted by Michael Krauss at 6:53 AM

February 23, 2010

Low doses of Wyeth’s Prempro, a combination of both kinds of female hormones, progesterones and estrogen, have been proven to relieve hot flashes, night sweats, and vaginal symptoms of menopause. But does Hormone Replacement Therapy cause breast cancer? This is a controversial question. The well-regarded Toronto Breast Cancer Study reported that women who received HRT for less than 15 years are not at increased risk of breast cancer. On the other hand a New Zealand study suggested that women taking may be at higher risk for breast cancer during the first 5 years, but therapy for more than 5 years confers no increased risk of breast cancer. Then the Women’s Health Initiative (WHI) study found an increased risk of heart attacks, stroke, breast cancer, blood clots, and pulmonary emboli (blood clots in the lungs) in postmenopausal women (50-79 years old) who took progesterone in combination with estrogens for 5 years. The WHI study received national notoriety because it was discontinued early because of its finding that HRT correlated to an increased risk of invasive breast cancer and other health problems. The study found that among those taking Prempro-like hormone replacement therapy, the rate of breast cancer was 38 per 10,000 women per year. Among those taking placebo, the rate was 30 per 10,000 women per year.

This study has now cost Wyeth, the producer of Prempro, over $9 million. In Singleton v. Wyeth, a Philadelphia jury decided that Wyeth should pay $6 million in punitive damages and $3.45 million in compensatory damages for failing to adequately warn a patient and her doctor about the increased risk of breast cancer. Here’s the law.com summary of the case.

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