A PERFECT MATCH?
The risks and rewards of hormone replacement therapy.
Even after nearly 40 years of use, hormone replacement remains a source of confusion for women and the doctors who treat them. During the early development stages of hormone replacement, it was thought that synthetic hormones could safely alleviate the symptoms of menopause. Now that pendulum has swung swiftly in the opposite direction, with the consensus urging women to avoid all forms of this treatment. Many patients are now choosing bioidentical hormones as a safer alternative for menopause-related discomfort.
Hormone replacement therapy was developed in the early 1940s for several reasons, including the treatment of menopause symptoms like hot flashes, night sweats, headaches, joint pain, mood swings, vaginal dryness and fatigue.
Hormones act like little messengers throughout the body, turning on or off certain signals. The messengers stimulate, strengthen and maintain the vitality and integrity of many tissues in the body. As certain hormone levels decline, the organs that they effect will also change in their function. For example, as estrogen decreases, vaginal lubrication declines. Estrogen is also thought to play a role in mental function. Many women complain of brain fog related to the declining levels of estrogen associated with menopause.
Doctors began “replacing” deficient estrogen and progesterone with adequate amounts of synthetic versions. These versions (brands like Premarin and PremPro), used for years, did alleviate discomfort for many patients. Initial debates over the safety of these hormones subisided with the prevailing belief that hormone replacement helped decrease the risk of chronic diseases like heart disease.
Finally, a detailed study by the Women's Health Initiative examining the benefit of synthetic hormone replacement for chronic disease uncovered the opposite; that hormone replacement actually increased the risk for heart disease and cancer [1]. The verdict was in. After the widespread press release of the results, women and doctors began to rapidly abandon the method.
Today, treatment decisions in relation to hormone replacement depend on the extent of the patient’s symptoms. Many women experience declining hormones in their mid-30s, while for others, menopause symptoms take hold after age 50. Some women will experience very few, if any, symptoms, while others battle extreme discomfort. Weighing the benefits of relief from against the risks that conventional hormone therapy can bring is a challenging task for patients.
For nearly 25 years, many doctors and women have been using a form of hormone replacement called bioidentical hormone replacement therapy (BHRT). This treatment only uses versions of hormones that are identical to the form of hormones that the body makes. For example, traditional hormone replacement used progestin to mimic the body’s own hormone, progesterone. Though the structure of the progestin may look similar to the body’s natural product, it's not an exact match.
Many experts feel that by introducing a hormone that is identical to the body’s, that body will know how to better utilize and dispose of that hormone. The same might not hold true for the “kind of identical,” which can also increase risk for chronic diseases.
This treatment has certainly had its share of hurdles. For starters, any hormone found naturally in the body cannot receive a patent. In order to obtain a patent, drug companies must manipulate the hormone into a compound that is not exactly identical to the natural structure. Many doctors and patients argue that this change brings us right back to many of the problems patients experience with the traditional forms of hormone replacement.
Actress Suzane Somers famously penned several books on her positive experiences with bioidentical hormones, including Ageless and The Sexy Years. Such public exposure led many other consumers to investigate bioidentical hormone options.
The question remains, how safe is any type of hormone treatment? Well, some professionals argue that bioidentical hormones are unsafe due to a lack of research. That's not the whole truth. It is true that more research is needed to guide doctors and patients. However, bioidentical hormones are not new territory. Treatment plans for diabetes, low thyroid, low testosterone and even melatonin all include forms of bioidentical hormone replacement. Any hormone treatment, bioidentical or not, has the ability to present harm if it is not used in balance with the regular systems of the body.
The hormone replacement issue should not overshadow a good foundation of health as a way to minimize the effects of menopause, as well as risk factors for diseases like heart disease and cancer. Consuming at least five servings of fruits and vegetables a day is known to help prevent chronic illness. A regimen of stress management, sleep and exercise is needed to help strengthen the heart, keep bones strong and help keep a balanced mind and spirit. Too much stress can impact menopausal symptoms. Sleep can be very difficult with ongoing hot flashes, but you have to first allot enough time for adequate rest. Consuming extra sugar remains a huge problem in this country. The risk factors that each of us control - diet, exercise and stress - will be the biggest assests in disease prevention.
Reference:
1. Rossouw, JE. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA, 288(3):321-33.
Other Trusted Sources:
The North American Menopause Society
Medline Plus
Mayo Clinic
