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HORMONES -
RISKS & BENEFITS OF HRT

Risks vs. Benefits of Hormone Replacement Therapy and The Advantages of Bio-Identical HRT

The Women’s Health Initiative study was designed to identify the potential risks and benefits of Hormone Replacement Therapy (HRT). A portion of the clinical trial was stopped early after results showed that a synthetic hormone combination increased the women’s risks of developing invasive breast cancer, heart disease, stroke, and blood clots. The data and safety monitoring board concluded that the risks of using a synthetic estrogen - synthetic progestin drug combination outweighed the benefits.

It is interesting that the researchers considered this finding to be “news”. In fact, many published clinical trials have already reported that the risk of breast cancer is increased by long-term use of conjugated equine estrogens, and further increases when the synthetic progestin medroxyprogesterone acetate is added to the regimen.

At our pharmacy, we compound customized bio-identical hormones including estriol, estrone, estradiol, progesterone, and testosterone, using the exact dose of the specific bio-identical hormones needed by each woman in the most appropriate dosage form for that individual. This customization allows the prescriber to maximize the therapeutic benefits that can be obtained through the use of bio-identical hormones, while minimizing the potential for adverse effects.

Bio-identical hormones were NOT used in the WHI study. Bio-identical hormones are structurally identical to hormones that are naturally produced by the human body, and intended to replace these hormones when their levels decline either as a consequence of aging, disease, or surgery. Research has shown that bio-identical hormones can effectively control symptoms of menopause, including hot flashes, insomnia, vaginal dryness, and frequent urinary tract infections. Women's experiences and clinical outcomes of HRT differ vastly depending on whether the hormones are synthetic or bio-identical, the dose, dosage form, and route of administration. For years, physicians have been prescribing bio-identical HRT for women who have experienced problems or have other concerns about the use of synthetic hormones.

Progesterone is a term that is incorrectly used interchangeably to describe both natural bio-identical progesterone and synthetic substitutes. Synthetic progestins (also called progestogens or progestational agents) are derivatives of bio-identical progesterone, and have been developed because they are longer-lasting, more potent, and patentable. Although synthetic progestins such as medroxyprogesterone acetate are clearly beneficial in preventing estrogen-induced overgrowth of the uterine lining and endometrial cancer, their other effects may be less desirable. Medroxyprogesterone can negate the beneficial effects of estrogen on lipid profiles, atherosclerosis, and vascular reactivity. Natural progesterone, on the other hand, can maintain the benefits of estrogen on cholesterol while minimizing the side effects associated with synthetic progestins.

According to some studies, medroxyprogesterone may reduce the dilatory effect of estrogens on coronary arteries, increase the progression of coronary artery atherosclerosis, increase the clot-forming potential of atherosclerotic plaques, promote insulin resistance and consequent hyperglycemia (high blood sugar), and may significantly lower high density lipoproteins (HDL, “good cholesterol”), thereby decreasing the cardioprotective benefit of estrogen therapy. Studies at Wake Forest University School of Medicine have concluded that synthetic medroxyprogesterone, in contrast to bio-identical progesterone, increases the risk of coronary vasospasm. Bio-identical progesterone plus estradiol protected against vasospasm.

The benefits of progesterone are not limited to prevention of endometrial cancer in women who are receiving estrogen replacement. Progesterone can build bone density, promote glucose utilization, and improve sleep patterns. Mayo Clinic researchers surveyed 176 women taking natural micronized progesterone who had previously taken synthetic progestins. After one to six months, the women reported an overall 34% increase in satisfaction on micronized progesterone compared to their previous HRT, reporting these improvements: 50% in hot flashes, 42% in depression, and 47% in anxiety. Micronized progesterone was also more effective in controlling breakthrough bleeding.

When considering treatment options for preventing heart disease and osteoporosis and relieving menopausal symptoms, it is important to address not only benefit-versus-risk ratios but also quality-of-life. A woman’s need for HRT may transcend statistics of heart disease, osteoporosis, and cancer. Without HRT, many women (and consequently, their families) feel totally miserable, exhausted, and unable to cope. Yet, only 20% of women continue to take synthetic hormones after two years, mainly due to the development of side effects. The quality of many women’s lives has been dramatically improved through the use of bio-identical HRT. 

Statistics and fear abound, yet the absolute risk of cancer attributable to HRT remains low, and the risk of some forms of cancer is reduced. For example, an analysis of 18 studies involving thousands of women concluded that the risk of developing colorectal cancer is reduced by 34% in current estrogen users.

Decisions about whether to stop, start, or change your HRT should made on an individual basis only after consulting your physician and a knowledgeable pharmacist. Our goal is to work together with physician and patient to solve medication problems and optimize each patient’s health and well-being.

Studies and the media continue to provide conflicting and confusing information. We are here to help clarify the issues that surround HRT. Your questions are welcome. The Compounder, 630-859-0333 or contact us by email at Larry@thecompounder.com