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Hormone Replacement Therapy:
Part I

By Linda Vaughon

Menopausal women are in a quandary as to whether they should or should not use synthetic Hormone Replacement Therapy (HRT).

At menopause, symptoms occur such as hot flashes, night sweats, insomnia, mood swings, and weight gain as hormones decrease.
The average age of menopause is about 51, at which time HRT can be used to replace hormones, which alleviates some symptoms of menopause.

The Department of Health and Human Services, the National Institute of Health and the National Heart and Lung and Blood Institute established the Women’s Health Initiative (WHI).

The WHI studies were conducted on two groups of women that were using either estrogen plus progestin (E+P) or estrogen-alone (E-alone) according to the Web site www.nhlbi.gov/whi.

The studies were done on women with full hysterectomies taking E-alone, and on women with uteruses taking the combination, E+P.
Women with uteruses take the combination because the use of E-alone for 10 years or more showed increased risk of ovarian cancer.
However, be warned that the findings for the two studies shouldn’t be compared directly because of differences in the women’s characteristics at the onset of the studies.

For example, those in the E-alone studies had a higher risk of cardiovascular disease than those in the E+P studies.

Women in the E-alone study were more likely to have heart disease risks factors such as high blood pressure, high blood cholesterol, diabetes and obesity.

The studies of E+P showed increased risk of heart attack, stroke, blood clots, breast cancer, but showed a reduced risk of colorectal cancer and fewer fractures.

No protection against mild cognitive impairment was found and there was an increased risk of dementia (study included only women 65 and older).
The investigators concluded that the ingestion of E+P caused overall risks that outweighed the benefits.
The E-alone studies showed no difference in risk for heart attack, but showed an increased risk of stroke, and blood clots. The study further revealed an uncertain effect for breast cancer.

The E-alone studies also showed no
difference in the risk for colorectal cancer, and reduced the risk of fractures. The findings about memory and cognitive function are not yet available.

Cognitive participants were to be followed annually with testing until 2005 in the Women’s Health Initiative Memory (WHIM). Results will be available in 2007 according to WHIMS’ Web site www.wfubmc.edu/whims/.

Following all of this testing, the U.S Food and Drug Administration (FDA) recommended that HRT only be used to treat menopausal symptoms and be used in the smallest effective dose and for the shortest time.
However, short-term use of hormones was not uniformly safer. Most outcomes developed soon after the study began according to the Palo Alto Medical foundation, a healthcare, education foundation at Web site www.pamf.org/.

Now, following the barrage of reports, women must attempt to determine what the best course of action is to combat menopausal symptoms. In the next issue of Senior Guide we will look at some possible alternative options women have at their disposal in these
changing times.

Part two In the last issue, reports made public through the Women’s Health Initiative (WHI) on the effects of synthetic hormone replacement therapy (HRT) were presented.

The investigators stated that the risks of estrogen plus progestin outweighed the benefits.
The Food & Drug Administration (FDA) advised that HRT only be used to treat menopausal symptoms and be used in the smallest effective dose for the shortest time. With this new information, menopausal women must make choices.

In a nutshell, women have three choices. They may submit to synthetic HRT, find a natural solution, or brave menopause with no aid.

The foundation “Women to Women” has shed some light on alternative menopausal treatments. Women to Women is an organization devoted to women’s health care “for women and by women” according to Web site http://womentowomen.com. It was founded through a medical clinic by Christiane Northrup, MD., Marcelle Pick, OB/GYN., NP., Mary Ellen Fenn, MD., and Annie Rafter, NP.

One choice of alternative menopausal treatment presented by Women to Women is bioidentical hormones. Bioidentical hormones are manufactured to have the same molecular structure as hormones produced by a woman’s body.
Bioidentical hormones have not been shown to have the same risks as synthetic hormones in thorough-studies in Europe, but more study is needed on their long-term use.
Famous for promoting this therapy is Suzanne Somers, the former star of the popular sitcoms “Three’s Company,” and “Step by Step.” Her book, “The Sexy Years,” is a source of information for women considering bioidentical hormones.

Also suggested by Women to Women is soy, which helps relieve menopausal symptoms. However, 80-160 mg. of soy isoflavones is needed to be therapeutic. Phytoestrogens in soy compensate for estrogen loss.

Black cohosh, taken twice daily, can also help. It has been well studied in Europe and appears to be safe and effective in long-term use. Although, a small percentage of women experience gastric upset initially.

However, beware that when synthetic HRT is stopped abruptly without support menopausal symptoms reoccur for most women. This is a withdrawal from the synthetic hormones, on which the body has become dependent.
Another problem occurs when switching from synthetic HRT to natural estrogen. The receptors have been primed by the synthetic molecule and can’t receive other forms including a woman’s own.
But some good news is that some women make testosterone in other areas of the body, such as the adrenal glands, but this adaptation can take time.

Also to be noted, many menopausal symptoms are the result of a life long unhealthy lifestyle. Throughout life, expectations are placed on the body which are not supported by stress reduction methods, proper nutrition, and exercise.

Therefore, whatever method is chosen to combat menopause, it is recommended that women eat properly, take a good supplement, exercise, and reduce stress.

When hormones are in balance women have vitality, sleep soundly, have a strong libido, look great, and have a well-functioning digestive and immune system. Women can feel this way from adulthood to their 70’s and upward with proper support.