Hormone replacement therapy

Everybody’s heard about this study and it’s really old news by now, but after seeing a TV ad by a local doctor promoting “natural” hormones I decided to put in my own two cents. Could it be that menopause is really the only natural way to go?

Here’s the background: one of the largest and best-designed studies on hormone replacement therapy was halted when it was found that the women who were on the hormones had a higher rate of breast cancer, heart attack, stroke and blood clots than those on placebo (JAMA 2002;288:321-333). The hormones in the study were Premarin, a horse-derived estrogen, and Progestin, a synthetic analog of progesterone.

In fact, there was nothing so surprising about this study other than the enormous news coverage it received. Previous studies, some of them covered in earlier issues of this newsletter, had reached similar conclusions but received little public attention.

So should women take “natural” hormones instead? So-called natural hormones are actually synthetically reacted from a common plant steroid. The plant material is not itself a hormone in humans, but it can be manipulated in the laboratory to make any sex hormone. These plant-derived hormones are actually best defined as “bio-identical” in that they are exactly the same as hormones produced naturally in humans.

As strange as it may seem, bio-identical hormones have never been adopted in medicine as the standard for hormone replacement therapy. Instead, some hormones were taken from horses (and the horses were treated very inhumanely in the process) and others were manufactured from chemicals. The reason is that natural, or bio-identical, hormones cannot be patented and pharmaceutical companies have no interest in promoting them.

But the question remains: are natural hormones safe? Unfortunately, there is not a single study evaluating their safety, primarily due to lack of funding. These substances have been approved for use simply because they are natural and, consequently, presumed to be safe.

Some experts hold that they are safe because they are from a natural source, plants, and are identical to those made by the human body. This type of reasoning never completely satisfies my curiosity – is menopause then a mistake? A well-known fact among researchers is that early menarche and late menopause are themselves risk factors for breast cancer. Actually, for every year that menopause is delayed, the risk of cancer goes up (see Lancet Oncol 2001;2(3):133-40 and Breast Cancer Res Treat 2002;72(2):107-15 among others).

This does not imply that women’s sex hormones are unhealthy. It means that if exposure to these hormones becomes excessive or goes beyond a certain natural term, they may endanger a woman’s health. In this respect, menopause could be understood as a protective mechanism of nature.

Of course, the symptoms of menopause can be incapacitating. In most cases I have found herbal medicines to be very effective, especially if they are expertly selected and combined. Herbs are the only true natural solution for the symptoms of menopause, and they are a solution that has been used for thousands of years. For women who do not respond to herbal remedies, I would suggest using natural hormones until the symptoms subside.

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