BioIdentical Hormone Replacement

Hormone Replacement Therapy has become extremely controversial, but more importantly the media’s coverage of the research behind their claims is shoving unnecessary fear into the hearts and minds of the American public. I’d like to share with you the history of hormone replacement therapy, the research results and the interpretations that are misleading the public. I must first say that physicians who have access and ability to interpret the research are also contributing to the chaos revolving this extremely important topic, as many have fallen prey of the multi-billion dollar pharmaceutical industry. My passion is about education. My focus as a physician is to release fear from health care and to work with patients in partnership to create the path of healing that is most comfortable for them. My goal here is to put out the fire regarding the truth about hormone replacement therapy and to allow the recipient of health care to make informed choices. If after reading this article, you choose to become active, there is a letter that you can print and send to your congressman. I probably received over 100 letters from proactive leaders in medicine – this is just one example.

First of all, let’s review together where the word “hysterectomy” came from. Prior to knowing what menopause was (cessation of ovarian follicle release), women between the age of 48-52 became “hysterical”. The most obvious symptoms were irregular uterine bleeding which was “fixed” by removing the tissue (uterus) that was showing us physical symptoms. The “show” of blood went away, but the emotional lability that was associated with it stayed.

The FDA approved estrogen for menopausal symptoms in 1941. Premarin came to market in 1949 with an aggressive marketing campaign and became the number one drug sold in the US for two decades spanning the 80’s and 90’s. This drug powerhouse took an abrupt fall in early 2000, when the results of two different research projects got the publics awareness.

Birth Control Pills (BCP) came to market in the 1960’s. After ten years of prescribing the leading contraceptive choice, research suggested that BCP’s increased the risk of irregular pap smears, stroke, deep vein thrombosis (blood clots), pulmonary embolism (clot in the lungs) and heart attack. This is about the same time in history that the medical community realized the danger of unopposed estrogen (estrogen supplementation without the use of progesterone), dramatically increased the risk of uterine cancer. As a result, women with a uterus on estrogen therapy had to also take a “progesterone” supplement to protect the uterus, and indeed it did.

More good news came from the pharmaceutical industry in the 80’s and 90’s…the benefit of estrogen therapy in preventing the #1 killer of women - cardiovascular disease. As women age, their estrogen drops and their risk of a cardiovascular event increases from 1:17 to 1:4 in the post menopausal years. This does point to the beneficial effects of hormones on the body. The makers of Premarin, Wyeth-Ayerst made sure to prove that estrogen decreased plaque buildup in the coronary vessels by up to 40% and sales continued to increase. The other benefits of estrogen noted in the literature were; stopped hot flashes, prevented vaginal atrophy, prevents osteoporosis, prevents alzheimers, prevents depression.

In early 2000, studies came out opposing the benefits that leading pharmaceutical company, Wyeth-Ayerst proclaimed.
• HERS study – Heart and Estrogen/Progestin Replacement Study – results showed that in women who already had heart disease, the combination therapy increased risk further rather than decreased it, even though cholesterol levels did improve. This study followed just under 2800 women with the average age of 67 years for 4 years. During the first year the women not on the placebo suffered more heart attacks during the first year but averaged out to be about the same over the four year study. The suggestion from epidemiologists are to start HRT sooner as once heart disease has started, it is too late to have a positive effect, indicating the usefulness of prevention, not treatment.
• WHI – Women’s Health Initiative had 2 arms; one arm consisted of Premarin with Provera was halted after 5 ½ yrs due to the increased risk of cardiovascular disease, blood clots, stroke, and breast cancer, (but at lower risk for fracture and colon cancer). The other arm consisted of estrogen only and lasted approximately 7 years, showed a 30% decrease in cardiovascular plaque with no other increase or decrease risks. Approximately 160,000 women were in this study. This study beautifully demonstrated the benefits of estrogen and the risks of synthetic progesterone.
• PEPI – Post menopausal Estrogen/Progesterone Intervention trial began in 1987 and involved 875 women betwee
45 – 64 years of age broken into 3 groups; (1) estrogen only, (2) estrogen + progesterone, (3) placebo. Groups 1 and 2 showed significant increase in good cholesterol and decrease in bad cholesterol. The difference in this study was the use of bioidentical progesterone rather than synthetic progesterone. Synthetic progesterone is the molecule that should receive the fearful attachment and yet the media presents it as “all hormone replacement therapy is risky and should be used for the shortest amount of time in the lowest dosages”.

In the journal of Clinical Endocrinology and Metabolism, Dr. Mark Blackman from John Hopkins University published his findings of a five year study of combined testosterone, estrogen and progesterone. This study had several arms and demonstrated that the only participants who did not receive benefits were the ones not on hormones. The benefits far outweighed the risks. The list below is a summary of what he witnessed in his studyn • Reduction of body fatn • Reduction of heart disease and arterial plaque.
• Improved energy, strength, endurance, muscle tone and exercise capacity.
• Improved vitality and quality of life.
• Improvement in strength of hair, skin and nails.
• Improved sleep.
• Reduction of cholesterol and triglycerides.
• Decrease incidence of heart disease and diabetesn • Decrease of breast cancer incidence when on progesterone therapy

In my personal experience, as well as that witnessed by practitioners of Functional Medicine as referenced in the Textbook of Functional Medicine, is that the benefits outweigh the risks of BHRT especially when attention is put on the safety of taking them. There is a blood test that I require for my patients on BHRT which tells me how a person is metabolizing the hormones. They can either be eliminated safely or not eliminated well and stored in the body which ends up being a risk. Although I am interested in blood hormone levels, I’m most interested in understanding the safety of offering a body hormones. If the levels come up low, antioxidants usually do the trick. The treatment is determined by the individual results.

Optimal outcomes occur as we minimize body toxicity and enhance hormonal strength. This means that taken respectively, BHRT offers two things.
1. BHRT minimizes disease outcomes that are associated with aging.
2. BHRT increases the quality of life.

In addition, consciously reducing toxicity that occurs simply by living at the same time of taking BHRT significantly impacts both benefits listed above.

Hopefully you now understand that estrogen is not the culprit of increasing cancer and cardiovascular risks, progesterone-like molecules (artificial progesterone, progestin) is the biggest culprit. Taking hormones that are identical to our hormones are beneficial to the aging process. Due to our understanding of this, the pharmaceutical industry is feverishly looking for ways to capitalize on this, but is having trouble as it is unethical to capitalize on natural products if you are a drug company.

The place the government is starting is with banning estriol. Once this is accomplished, the next step will be to ban compounded progesterone. Right now the only type of BHRT available through non-compounding pharmacies is estradiol and progesterone by the name of Prometrium. The problem I have with Prometrium is that it is made from peanut oil – a common allergen. There is no other progesterone available through a pharmacy except for compounding pharmacies. In addition, estradiol is best taken in the form of a troche (dissolvable form in cheek or under tongue) as it bypasses the liver’s first pass and is therefore safer. You can only get this form from a compounding pharmacy or use a patch. Most BHRT estrogen contains estriol … and so now you understand the whole circle.

So, guess what is happening! The public is being scared by two points that the media is portraying!
1. They are comparing apples to oranges, (progestin to progesterone)
2. They are misinterpreting study outcomes (all hormones are unsafe rather than synthetic hormones being unsafe)

I must say, they are brilliant! Why? Pharmaceutical companies are creating a devastating medical situation that will find a heroic answer to! Their answer will be an alteration of BHRT, but sold as BHRT through drug companies.

There already exists an answer, before the problem gets worse … BHRT. Guess who wins here … the health care consumer (you), Compounding Pharmacies who take the time to create appropriate proactive options, and physicians who take time to educate the public and partner with you on your journey of wellness. The time and energy is fulfilling as we can all participate in benefiting the health of America proactively rather than the way our primary medical model currently works – reactively! Emergent medicine should be a reactive medicine – what I’m offering is to be proactive in preventing chronic degenerative disease.