The idea of hormone replacement therapy has many women “clutching their pearls” and covering their breasts. Why? Because many are confused about hormones and simply not aware of the evidence. In this four-part series, “What You Need to Know About Bioidentical Hormone Therapy we are going to clarify the misunderstandings and clear up any misconceptions. We will begin by discussing the difference between Hormone Replacement Therapy (HRT) and Bioidentical Hormone Replacement Therapy (BHRT)
The hormones we are discussing as it relates to this topic are estrogen and progesterone. These two (among others) are naturally produced in the body. Estrogen tells the cells to “grow” and progesterone tells the cells to slow down growth. The effects of estrogen and progesterone are commonly recognized in the menstrual cycle. Estrogen is more dominant during the first part of a woman’s cycle, (causing the growth of the uterine lining) and progesterone is more dominant in the second half of the cycle, slowing down the growth of the uterine lining (among other things) prior to menstruation. They work together in a woman’s body for health and homeostasis. One should not be replaced without the other.
The difference between HRT and BHRT
Synthetic hormones are manufactured in a laboratory or hormones from animals. They are similar but not precisely the same as the hormones that are made in the body atom for atom. Why is this important? Synthetic hormones are not exact copies of body-made hormones and are not recognized utilized, metabolized and excreted by the body in the same way that an exact copy would.
The difference in molecular structure of synthetic hormones will elicit a different, and many times, an undesired response in the body. The original HRT was actually ERT, Estrogen Replacement Therapy and it began back in the 1930’s. Pharmaceutical companies manufactured estrogen primarily from pregnant horse’s urine. (Premarin) and it was one of popular prescribed drugs by physicians in the 1970’s.
Although Premarin was from a natural source, estrogen from a pregnant horse is not an ideal replacement for humans because they are not a one-to-one duplicate of our own hormones so it will not deliver the same information to the cell. Additionally, estrogen should not be replaced without the progesterone to oppose the effects of estrogen’s growth signals.
There were side effects to ERT, enlarged, painful breasts, cystic breasts, anxiety, irritability, headaches, fluid retention, allergic reactions to the synthetic estrogen, and what many feared, cancer. To counteract the effect of unopposed estrogen (cell growth out of control), progestin (synthetic form of progesterone) was added to ERT and became HRT, Hormone Replacement Therapy.
Synthetic progestins did slow down uterine cell growth from estrogen-only replacement decreasing the risk of uterine cancer but created another problem. It has a harmful effect on breast tissue. Synthetic progestins and pregnant horse’s estrogen have a higher incidence of breast cancer than women on ERT only or with bioidentical progesterone.
Remember, synthetic progestins are not the same as progesterone produced in the body or bioidentical progesterone. Synthetic progestins promote excessive breast tissue growth. In addition to breast cancer, progestins have also been linked to blood clots, weight gain, fluid retention, acne, rashes, depression and a slew of other conditions.
Bioidentical hormones replacement is replacing the hormones naturally made in the body with ones that are exact equivalent in structure, molecule and atom to the ones our bodies produce on its own. They can also be called “Body Identical” because they are an exact copy or replica, atom for atom, and they deliver the exact same message to hormone receptors and the body recognizes these messages.
They are utilized, metabolized and excreted from the body just like our own hormones are. Bioidentical hormones are made from either yam or soy. Bioidentical hormones work similarly to putting the right key into the right lock. It will open the door you want to be opened. Bioidentical hormone replacement does not promote excessive tissue growth and protects the cardiovascular system, bones, brain and breasts. It also supports proper metabolic function and other hormones like insulin, ghrelin, leptin and cortisol.
The WHI study and it’s re-analysis
The Women’s Health Initiative (WHI) began a study in 1991 to look at the common causes of death and disability in menopausal women, heart disease, cancer and bone loss. determine whether HRT was keeping women healthier and younger for longer and to see how hormones, diet, vitamin and mineral supplements would affect the quality of life of menopausal women.
Did HRT prevent disease and slow down aging or not? Dr. D. Lindsey Berkson takes a deep dive into this study in her book, “Safe Hormones, Smart Women”. The study used Premarin, an oral pill made from horse estrogen and synthetic progestin or horse estrogen only. There were two arms if the study. The first arm was of over 8,000 women on Prempro (a combination of horse estrogen and a synthetic progestin and 8,000 women on a placebo. The second arm of the study was of 5,000 women without uteruses taking Premarin only (horse estrogen) and women without uteruses on placebo.
Many times, women without a uterus are given estrogen only replacement. It should be noted that the women used in these studies were older, average age being 63 but up to 79 years of age. Ideally HRT starts much earlier. It should also be noted that the many of the women in this study were smokers, overweight and had a poor diet. In July of 2002 the first trial ended prematurely. We have already discussed that horse estrogen is not good for humans and progestins have many harmful effects. The results of the study turned HRT upside down.
A little over 5 years into an 8-year study, there were small increases in breast cancer, heart attack, stroke and uterine cancer. The second arm of the study of the study showed that estrogen-only replacement therapy seemed to increase the risk of stroke. Here is the good news about the second arm of the study, which, by the way, is not widely known or discussed. The second study showed that after about 7 years on horse estrogen without synthetic progestins, breast cancer was reduced by 31%. Remember this is with Premarin, horse estrogen which is not ideal for humans.
Younger women in the study (between the ages of 50-59) showed slower growth or arterial plaque in their arteries meaning that estrogen (from horses, not deal) had a protective benefit to the heart. The study was shut down early and the takeaway was the estrogen caused breast cancer. Naturally doctors were upset and stopped prescribing HRT.
Women became fearful that estrogen was cancer-causing. Sadly, after the WHI study, nobody was paying attention to the benefits and HRT got a bad rap. Later on, controversy developed over the study. Many involved in the study asserted that it was flawed and the findings were largely inaccurate. Some scientists and physicians were worried that women were being denied the protective benefits of HRT. So, there’s the good and the bad of horse estrogen which is not ideal for humans and synthetic progestins which are not natural or bioidentical to progesterone produced by the body and have deleterious effects on women’s health. Side note: progestins are in birth control pills. They are named medroxyprogesterone acetate, which was used in the WHI study, Norethisterone and norgestrel, Dydrogesterone, dedrogestone and megestrol. Let’s now discuss the safety and of Bioidentical Hormone Replacement Therapy, BHRT.
Safety of BHRT (reference studies)
To recap from earlier, bioidentical hormones or “body identical” are best because they are an exact copy of the hormones produced in the body, they provide the exact same messaging to hormone receptors, are recognized by the body, are utilized, metabolized and excreted from the body just like our own hormones are. Bioidentical hormones are made from either yam or soy. These factors make BHRT more safe than synthetic hormones or CEE, Conjugated Equine Estrogen (Premarin). We have estrogen receptors throughout the body. Our overall health as women is dependent on having adequate levels of estrogen. Let’s talk about timing of BHRT. It appears that BHRT is most safe when started within the first 10 years of menopause. Women who are healthy when starting BHRT seem to stay that way.
Shelley R. Salpeter stated in the Journal of Internal Medicine, Mortality associated with hormone replacement therapy in younger and older women said that women start replacing their hormones under age 60 reduce the possibility of death from a variety of causes such as cardiovascular disease and cancer. Even taking BHRT short term can have long lasting positive effects.
For example, researchers at the Center for Clinical and Basic Research in Ballerup, Denmark gave half a group of menopausal women hormone replacement. Women on hormone replacement for only two to three years had fewer fractures than those who had never taken hormones and protection continued for the next 5-15 years. We have estrogen receptors in the brain. BHRT show good effects on brain function. At normal levels, estrogen prevents depression and insomnia, increases concentration, and maintains a normal sex drive.
The study from the University of Arizona insurance has the most startling results of estrogen on the brain. It showed a 75% reduction of incidence of Alzheimer’s disease and dementia in women on bioidentical estrogen hormone therapies for 6 years or more. Bioidentical hormone replacement has associated with lower abdominal fat accumulation, better insulin sensitivity, and reduction in heart disease.
Allan Lieberman et al. Altern Ther Health Med. 2017 Nov. Pub med A meta-analysis of 3 studies involving 86 881 postmenopausal women reported that the use of natural progesterone was associated with a significantly lower risk of breast cancer compared with synthetic progestins. Use of natural progesterone has been linked to lower rates of uterine and colon cancers and may also be useful in treating other cancers such as ovarian, melanoma, mesothelioma, and prostate.
Progesterone may also be helpful in preventing cardiovascular disease and preventing and treating neurodegenerative conditions such a stroke and traumatic brain injury. It promotes restorative sleep, protects against tissue damage from excess inflammation and maintains brain volume.
Let’s talk about the reanalysis of the WHI study done by Dr. Joseph Ragaz. He evaluated the “estrogen only” side of the trial. The American Association of Cancer Research published this article: Abstract PS7-05: Estrogen-based hormone replacement therapy [E-HRT] reduces all-cause, breast cancer, and Alzheimer’s dementia mortality, Annualized rates of mortality were taken for women aged 50-59, 60-69, 70-79, for breast cancer, Alzheimer’s dementia, and all-cause mortality. The average follow up was 18 years. Women on estrogen only HRT (without synthetic progestins) has a reduction of breast cancer by 32%. Deaths avoided by the use of E-HRT in the US population was estimated as follows: Breast Cancer, 9,292; Alzheimer’s dementia: 18,966; and all cause-mortality: 50,008.
Journal of the American Medical Association (JAMA) published articles in 2009 found that women who had been on estrogen replacement for six years, but followed for eleven years, had a 23% lower risk for invasive breast cancer compared to women who had been given placebo.
In 2011, JAMA published another article finding the same effect. Andrea La Croix, Ph.D., a scientist from the Fred Hutchinson Cancer Research Center in Seattle, found persistent that the protective effect of estrogen on breast tissue was unexpected but statistically solid. Another scientist, Dr. Craig Jordan, who invented Tamoxifen, and Dr. Leslie Ford, associate director for clinic research at the National Cancer Institute’s Division of Cancer Prevention, wrote an article called the Paradoxical Effect of Estrogen on Breast Cancer Risk. in this article showed that not only did estrogens sometimes prevent breast cancer, they cause breast cancer cells to die. Estrogen’s ability to do this seems to be activated by a lack of exposure to estrogen and the re-exposure to it. This is all good news! Sadly, fear of some in the medical community and many women persists even in light of the re-analysis.
Next When is the best time to start BHRT.
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