Benefit vs Risk

Does hormone replacement have more benefit than risk? Emerging science says yes!

2013 research demonstrates that bioidentical hormone replacement (BHRT) is a sensible consideration for most peri and postmenopausal women (and also for men).

However, science based, sensible hormonal replacement must be:

1.     Individualized

2.     Soundly tested and monitored

3.     The entire hormone family evaluated

4.     Key nutrients that assist in hormone signaling addressed

5.     Digestion evaluated to ensure key nutrient absorption

6.     Plus, there now there are even new answers for women (and men) months out from diagnosis of hormonally dependent diseases.

There is a revolution happening in our understanding and application of hormonal balancing in the treatment and prevention of aging issues and diseases.

NEW 2013 RESEARCH FROM TEXAS (Women’s Wellness Center, Tyler, Texas, USA)

  • Three-year randomized controlled trial on 75 women in peri/post menopause showed that bioidentical hormones in physiologic dosages (ranges similar to hormone levels in reproductive years) had positive, healthy effects on cardiac and inflammatory biomarkers, improved immune function, and with many favorable outcomes in spite of numerous women documenting high life stress.
  • BHRT was not associated with worsened stroke or heart markers or linked to any women having adverse (serious) health events.
  • Authors stated that BHRT is an effective and safe clinical therapy for peri- and post-menopausal women.
  • International Journal of Pharmacologic Compounding 2013 jan-Feb;17(1):74-85
  • I interviewed the main author in Safe Hormone, Smart Women (1000 scientific citation evidence-based book on the science behind BHRT. New revised audio edition now available at BodyMindHormone.com eStore)

 

RESEARCH FROM THE MAYO CLINIC  – ROCHESTER MINNESOTA

  • A randomized, blinded, four-arm 16-day clinical trial of forty postmenopausal women assigned to one of three doses of a compounded estrogen cream (Bi-est (80:20); 2.0, 2.5, or 3.0 mg)+compounded oral progesterone 100 mg, or to a conventional estradiol patch (Vivelle-Dot™ 0.05 mg)+Prometrium™ 100mg.
  • Serum levels of 3 major estrogens: estrone, estradiol, estriol, and progesterone were obtained.
  • Bioidentical vs. commercial hormone replacement were equally well tolerated.
  • Compounded hormones gave lowest blood levels of estrogens at a statistically significant level (beyond chance) compared to commercial estradiol patches.
  • Estriol levels remained low in all groups.
  • Serum progesterone levels were comparable in conventional vs. compounded groups.
  • Maturitas. 2013 Apr;74(4):375-82. doi: 10.1016/j.maturitas.2013.01.010. Epub 2013 Feb 4.

 

Much of the negative reports on HRT are due to synthetic hormones, the way the hormones are administered, or the age and health of the women given the hormones. Many headlines that makes HRT sound scary are not representing natural hormonal replacement. This makes it very confusing for the patient. And even the doctor. The Physicians Desk Reference and various scientific studies lump natural and synthetic together without adequately separating them and their differences. So this has put hormone replacement in a confusing light and understandably makes many people frightened of replacement.

 

Menopause is a train coming down the track.

Menopause demographics are huge and growing.

Aging picks up speed through the years, especially after the mid-50’s, but we have tools to slow this down, especially brain ‘shrinkage’.

 

1.     Menopause affects 25 million women worldwide yearly

2.     World Health Organization estimates 1.2 billion women will become postmenopausal by 2030

3.     After menopause women are at rapid, increased risk of many disorders and diseases from lung, heart, colon and brain to fatigue and sexual dysfunction. Within months of lower estrogen levels, lung tissue shrinks, bone mass begins to thin and cognition is affected as brain mass reduces.

4.     Balancing hormones has been scientifically shown (i.e. by brain MRIs) to stop, or reverse, many of these conditions that up to now have been considered inevitable side effects of aging. This information applies both to women and men!

 

What can women do to protect themselves? Do the benefits out weigh the risks of HRT or not?

Many integrative hormone experts (such as Drs. Jonathan V. Wright and David Rosensweet MDs) are now saying: The benefits of soundly monitored and tested hormone replacement far out weigh the risks.

 

Example of what’s in the news addressing Risk vs. Benefit of HRT.

 

PRO: In recent months the British Menopause Society said that the benefits so outweigh the risk of hormone replacement, there should be no time limit on duration, but each case, risk vs. benefit, individually assessed.

PRO: In March of 2012 the conservative North American Menopause Society came out with their 9th positional statement saying that hormone replacement is one of the best ways to address menopause issues, but it should be individualized.

CON: In contrast, the U.S. Preventive Services Task Force along with other professional groups has issued recommendations against the use of HRT to prevent chronic conditions. But the studies they evaluated used either horse estrogen, estrogen along with being opposed by natural protective progesterone, or included synthetic progestins, which have been definitively linked to increasing risk of nasty outcomes such as cancer and cardiovascular issues like stroke. POLSKIE ARCHIWUM MEDYCYNY WEWNĘTRZNE Journal 2013

PRO: In 2012, a Danish randomized controlled scientific 10-year study demonstrated that HRT reduced heart disease by 50% without increasing the risk of breast cancer or stroke; and that taking HRT in peri and early menopause gave protection for years to come. This study supported the “window-of-opportunity” (starting HRT before age 60, or within 10 years of menopause, and continued for six years or more) for maximal protection against heart disease and overall mortality and minimization of risks. The authors said that there is a substantial increase in quality-adjusted life-years over a 5 to 30-year period in women who initiate HRT in close proximity to menopause, supporting HRT as a highly cost-effective strategy for improving quality of the 2nd half of life.  British Medical Journal 2012

PRO: In 2012 the KEEPs study reported that hormone replacement significantly improved quality of life; including reduction in hot flashes and night sweats, improved bone density, lowering bad cholesterol, and increasing good cholesterol; women on topical estrogen had improvement or no effect on blood fats plus improvement of insulin sensitivity, a trend of less calcification in arteries, improvement in mood and sexual function, and no negative effect on cognition.  Medscape 2012

Bottom line:

Data has been robustly building up that the benefits of hormone replacement far out weigh the risks.

Risk is minimized the more we mimic mother nature using bioidentical molecules instead of synthetic ones, and emphasize dosage and cycling that overlap with what the body has been accustomed to throughout the earlier life-span.

It is also critical and clinically savvy to address the entire family of hormones as any one weak link, any one or two deficient hormones, can create an unexpected adverse response to hormone replacement and end up with the patient throwing the baby out with the hormonal bath water. This includes estriol, estradiol, estrone, free and total testosterone, DHEAS, progesterone, oxytocin, melatonin, adrenal hormones, free T3 and T4, rT3, insulin (which is a sugar hormone) and sometimes hormone metabolites and antibodies that have various activities.

For best results there needs to be consideration of the key nutrients that biochemically coordinate hormonal signaling. (One example is zinc).

These nutrient levels lean on optimal digestion, which is often faltering in aging persons. (Stomach acid, pancreatic enzymes, bile salts and how healthy and effective is the gut lining).

Any cogent and optimal hormonal replacement program should include individual testing and monitoring as each woman and man enters mid life with their own individual hormonal footprint that can only be assessed through an in-depth personal and familial intake along with proper testing.

Berkson’s audio or eBook, Safe Hormones, Smart Women are helpful to learn more the entire hormone story and the science behind BHRT, and see a doctor that can get you on a balanced hormonal road as soon as possible plus address nutrition, digestion and food. (Food choices influence hormone health).