October 7, 2010
By Lisa Lindley, M.D., FACOG
Let’s talk about hormone therapy. For years we thought hormones were the ruby slippers, the magic cure, and that everyone should be on them forever. Then in 2002, there was the WHI (Women’s Health Initiative) study. Publication of its data created a controversy over hormone therapy that continues today. There was a barrage of media coverage, filled with misinformation. Based on that, women and even many physicians decided that not only were hormones not the ruby slippers, they were poison apples. Women began throwing their hormones away, resigned to suffer the consequences. And suffer they did!
I heard many questions from my patients: “So what did this study say?” “What is the truth?” “What are the real risks and benefits of hormone therapy?” “Do hormones cause cancer?” “Are hormones right for me?”
My desire is not to have every woman taking hormones. My desire is that every woman becomes educated so she can make informed decisions about her hormones, not choices based on fear.
The WHI study was released in July 2002. It included 16,609 women, ages 50 to 79, with an average age of 63. The study was designed to review estrogen plus progesterone therapy in women who had not undergone hysterectomies. If these women chose to take hormones, they needed to take estrogen and progesterone. Progesterone balances the effects of estrogen on the uterus and prevents overgrowth of the uterine lining.
The medication being studied was Prempro, a combination of estrogen and progesterone. The estrogen component of Prempro is Premarin, a mixture of estrogens known as conjugated equine estrogens (CEE). These estrogens are obtained from the urine of pregnant mares, thus the name, PREgnant MARe urINE. The most abundant estrogen in Premarin is estrone sulfate. Once absorbed, estrone sulfate is converted to estradiol, a naturally occurring, bioidentical estrogen, the most active form of estrogen in women. Hormones marketed as bioidentical are synthesized from plants. In this case, bioidentical is a marketing term, not a medical designation. There are many bioidentical hormone options. Details about that would require another article.
The progesterone in Prempro is a progestin, medroxyprogesterone acetate. (That’s a mouthful, so we call it Provera, or just MPA.) Progestins were synthesized years ago, because women’s bloodstreams didn’t absorb the naturally occurring form of progesterone well enough to have a clinical effect. Too little of the medication survived digestion. The development of progestins gave us a useful form of oral progesterone and made birth control pills and hormone replacement therapy possible. All birth control pills contain progestin as the form of progesterone.
In July 2002, before the WHI results were published, and before physicians had a chance to review the data, media sources from CNN to the “New York Times” reported that women on hormones had a “26 percent increase in breast cancer.” Yikes! That’s more than one in four! I’d throw my hormones away too!
I am not sure that I agree with this perspective – but I posted it for you, the reader to decide. Even the National Institute of Health acknowledges the relationship between HRT and breast cancer. Breast cancer rates have gone down dramatically since the 2002 study and women stopped taking HRT. Synthetic hormones or anything else we put into our bodies are not good for our health. PERIOD.