A new, 18 year follow up study of 27,347 women was just released in the Journal of American Medicine (JAMA), and it has upended 15 years of advice doctors and caregivers have been giving their female patients. It concluded that women who take hormone replacement therapy (HRT) for 5-7 years to combat the symptoms of menopause do not suffer a shorter life expectancy than women who do not – as was previously believed from the 2002 Women’s Health Initiative (WHI) study. I acknowledge their conclusion as credible but can also see the limitations of this study in regard to types of hormone therapy, dosages and varying delivery modes of hormones that could have been used.
The results of the 2002 Women’s Health Initiative (WHI) results found a correlation between women who used synthetic hormones (Premarin, progestins) and those that were more likely to suffer premature death from breast cancer, uterine cancer and cardiovascular events.
Since that WHI landmark study, Bio-Identical hormone therapy (BHRT) has been the preferred method of hormone therapy during menopause compared to Synthetic Hormone Therapy (HRT). A 2006 Alternative Medicine Review article sites how bio-identical hormones are more closely matched to our own natural estrogen and progesterone structure than the synthetic forms and the efficacy of their use over synthetic hormone therapy.
What does that mean for women?
We can’t conclude from this new study that all HRT is safe for all women, but we can conclude that HRT & BHRT can be considered on an individual basis – looking at each women’s genetic risk, environmental factors and the length of administration of exogenous hormones.
A Personal Story of Bio-identical hormones…
I wanted to share a story with you about a patient of mine because her story is heart-breaking and unnecessary.
Let’s call her Carla. At age 42, Carla was having severe and bothersome symptoms of hormonal imbalance. Maybe we can relate to the soaked sheets and bedclothes at night causing disturbed sleep and non-productive work days. And the frequent hot flashes that leave you feeling out of control and irritable. She also had a very low sex drive that was interfering with her marriage and connection with her husband. She was looking for quick relief – and I don’t blame her at all.
Carla had read on the internet about Bio-identical hormones as a safe alternative to synthetic hormone therapy. She was desperate and wanted to banish these sudden and severe menopausal symptoms, so she found a doctor to prescribe them for her.
Almost instantly, the night sweats stopped, the hot flashes were much less severe and she even felt an improvement in her sex life. She was taking an estrogen cream with testosterone and progesterone pills at night. Life was good again…until, after a few months, she started getting other symptoms. Her fibrocystic breasts were always sore, she gained weight and she was having frequent spotting so her doctor lowered her dose. These are symptoms of getting too much estrogen.
On her follow up a visit to her prescribing doctor, she was told that it doesn’t make sense to do a lab test because she knew the estrogen levels were high. She lowered the dose and was told to come back in 6 months.
10 years later, Carla had occasional symptoms but was just happy to be rid of night sweats & hot flashes so she kept getting her prescription filled- with minimal follow up with her physician. Until the day she went in for a scheduled mammogram.
Carla got the call that no women want to get after having a mammogram. They wanted her to come back – they had found a particularly suspicious area. The radiologist reassured her that it was probably just due to the fibrocystic breast tissue. She was sent to get a breast biopsy.
But after the results of the biopsy were confirmed, her worst fears were acknowledged when she was diagnosed with breast cancer.
The aftermath of this diagnosis and treatment left her exhausted and disfigured from the daily radiation while working a full-time job. The fear of cancer coming back haunted her as she debated going on Tamoxifen to lower her estrogen.
Let’s back up for a minute. Does this scenario make sense?
I don’t have a crystal ball and I don’t know that Carla would never have developed breast cancer in the absence of taking exogenous hormones for 10 years, but I could bet on the odds. With fibrocystic breasts (estrogen dominance) and a history in her family of breast cancer, why was she ever put on hormones in the first place?
A 2008 follow up paper from the WHI clearly stated that taking hormones at higher levels than her body needed for more than 5 years gave her a high probability for developing breast cancer.
Look for the Source of the Imbalance
There are so many holistic options to approach the symptoms of peri-menopause and menopause before you decide to start hormone therapy. Investigating root causes like Your adrenal health is an important factor in how you navigate through peri-menopause & menopause. Managing your stress, eating a nutritionally balanced diet, exercising and finding your inner joy help to guide you through this natural transition in every women’s life. There are numerous herbal formulas, natural supplements and dietary programs to assist in this process to help you sleep better, flashless, feel calmer and live fuller lives.
What if you want to try Hormone Therapy?
I know from my experience working with women in my clinic for the last 15 years, that some women need more support than others. For some women, dietary & lifestyle changes are not enough. They may have a higher, individual need for estrogen, progesterone or testosterone that cannot be balanced with plant-based supplements or herbal formulations.
Maybe the emotional or physical stress they are experiencing is too great. Maybe there are other biochemical imbalances that must be addressed first – nutrient deficiencies, toxicity, gut infections, or an auto-immune process. These considerations must be taken into account – even if women want to start hormone therapy – to maintain optimal health.
Another consideration when taking HRT, is that the appropriate lab tests are followed. Labs that monitor not only hormone levels – but also monitor how you break down estrogens for elimination outof yourr body. Poor detoxification of estrogen can put you at risk for estrogen-related cancers.
Choosing hormone therapy for yourself is a personal decision that should not be done out of desperation or lack of resources. An informed choice should be made with your physician, after weighing the benefits and risk for your own body, your environmental triggers and your family history. Hormone therapy can be a game-changer for some, but it is definitely not meant for all women going through peri-menopause and menopause.