Hormone Replacement Therapy

Bioidentical Hormone Replacement Therapy.

Ever since the results of the Women’s Health Initiative study into the safety of HRT were published in 2002, people have sought safer alternatives to synthetic pharmaceutical drugs. That this should have happened is understandable. This massive study showed that women taking prescription or synthetic HRT were at an increased risk of developing breast cancer, stroke and blood clot, than were women not on such treatment.

The increased risk was small but real. Of 10,000 women not on HRT one could statistically expect 30 new cases of breast cancer to develop among them every year. If a similar group of 10,000 women were studied, only this time looking at those taking prescription HRT, one could expect 38 new cases of breast cancer to develop among them. Eight extra cases out of 10,000 women -- not very many but real nonetheless.

From this relentless yet understandable quest to find safer alternatives to synthetic pharmaceutical grade HRT has sprung an alternative industry that is a strange mixture of cult, religion and quasi-science. This is medical pseudoscience. At its heart is a Holy Grail of products called Bioidentical Hormones -- a largely meaningless term designed to impress and reassure all those attempting to Google their way to perfect health.

In establishing a religion it is always useful to instil fear at an early stage. To do this Bioequivalentologists call on the results of the Women’s Health Initiative study and talk about prescription approved HRT causing cancer, stroke and blood clot. All of which is correct of course. However there is an inference here is there not? In saying that there is an increased incidence of breast cancer for those taking FDA approved HRT it is inferred that there is no such increased risk for those taking unapproved, unproven concoctions compounded by the local chemist. Yet there is not a shred of evidence that that is the case.

On the contrary in fact. Wren and his colleagues conducted a double-blind, randomized, controlled trial on a “natural” chemist concocted progesterone cream and found that it had no effect and was not bio-available. Therefore women using this preparation while also using oestrogen are receiving no protection from developing endometrial cancer.        

As with any other religion it is a matter, not of science but of faith. All you are asked to do is to believe that Bioidentical Hormones are safer, better and more effective than their FDA approved pharmacological counterpart. This is, if you will, a central tenet of this religion, an article of faith. Bioidentical Hormones, individually run off by an approved (of course) Compounding Pharmacists are superior to those produced by an FDA approved Multinational Pharmaceutical Companies. You do not have to prove anything or produce any evidence in support of this. Like all good religions, all that is required of you is that you make an Act of Faith.

We need a few evangelists and a liturgy too of course. We need a few Gospels according to Celebrity if you like. So we are given scribes Suzan Somers and her Sexy Forever: How to Fight Fat After Forty to be follower by Hormone Balance Made Simple by Dr John Lee and for a little bedtime read you may have The Natural Superwoman by Dr Uzzi Reiss. Now parade all these authorities out in front of a global TV audiences on a regular bases and have Oprah Winfrey and Dr Christian Northrop nodding sagely in the background and you have a potent blend as good as any Bible or Koran or Torah, being beamed across the planet.

How about a little hocus pocus then as well while we are at it, a little voodoo perhaps? Yes, Bioidenticalology   has that too. They call it Saliva Hormone Assay. This is to appear to bring a bit of science to the party. The only problem is that, like most things to do with this subject, it is pseudoscience. Hormone levels in saliva are notoriously unreliable, expensive, bear no relationship to serum hormonal levels and throw no additional light on the diagnosis of menopause. Patients might feel reassured by them and doctors may feel justified in charging additional fees for them but that is as far as it goes.

Now lets create a few devils, lets get a few Lucifer’s around here – the personification of evil if you like. All religions have that don’t they? How about Horse’s Urine? Doesn’t that sound nice and nasty, kind of evil if you like? Well the next time you are riveted to some Bioidentical devotee rabbiting on about Natural Hormones check your watch and see how long it will take her to mention Horse’s Urine. What she will fail to mention is that the estrogens produced from non-vegetable sources, as for example equine estrogens, are converted in the human body into human estrogens, they are in fact Bioidentical at their point of action. In any case most prescription HRT is manufactured from vegetable sources such as the yam the so-called “natural” source the Bioequivalentologists would like to claim as their very own.

Another useful hate figure for this religion is the Multinational Pharmaceutical Industry. And while I’m no apologist for them, it is a bit rich I think to be wagging a finger at them while at the same time eulogising the activities of a network of compounding chemists and saliva analysers who collectively also constitute a similar Multinational Pharmaceutical Industry. The only real difference is that the former are required by law to comply to stringent rules and regulations while the latter are free to do whatever they like.  

At the end of the day the choice is yours. I carry no brief for anyone. Which would you prefer? To visit a doctor well versed in the art of hormone replacement therapy for women. To take under professional supervision a range of substances manufactured to strictly enforced GMP, proven in clinical trials to be absorbed into your body, proven in clinical trials to be effective, proven in clinic study to have a definitive range of dangers and made from “natural” ingredients.

Or would you perhaps prefer to trust a zealot and have your saliva analysed? Would you then take the word of some stranger in an unregulated laboratory to diagnose your menopausal condition? Would you then be happy to commit to a range of substances compounded without supervision or regulation, with no established bio-availability, no proven efficacy, no definitive range of dangers or side effects and made from the self same “natural” ingredients? Now you tell me.         

     

Doctor Rynne  www.doctorrynne.com

Hormonal Replacement Therapy for Women - Do women need testosterone

Hormonal Replacement Therapy for Women.

 Do women need testosterone?

Dr Andrew Rynne.

Up to the year 2002 hormone replacement therapy or HRT was almost standard treatment for all post-menopausal women suffering from symptoms of falling female sex hormone levels. Up to then, testosterone was not considered a female sex hormone of any significance. In the past ten years there have been some quite dramatic developments.

What are the most frequent symptoms of Menopause?

(1)   Frequent hot flushes.

(2)   Night sweats.

(3)   Vaginal dryness making sexual activity difficult or impossible.

(4)   Loss of libido and mild depression.

(5)   Hair and skin dryness.

(6)   Weight gain unrelated to over-eating.

(7)   Slowing down and eventual cessation of menstruation. Erratic menstrual periods.

What hormone levels fall at time of menopause?   

All female hormonal levels, including testosterone, fall around the time of menopause but the ones that cause the most symptoms are oestrogen, progesterone and testosterone. Testosterone is a steroid androgen hormone produced by the ovaries and adrenal glands. During early adulthood women produce testosterone at about 10% the rate that men do. As with men also, their levels of testosterone fall as they get older such that by menopause, or shortly thereafter, their testosterone levels fall to zero or near zero.

Testosterone levels in women.

Testosterone is now thought to play an important role in female libido and sexual response. Not all women, by any means, will experience a fall in their sex drive or function as a result of declining testosterone levels. Some however will and it is important to know that these women can be helped and need to be helped.  

Can these be replaced?

Yes, all three hormones can be replaced. In the case of post hysterectomy, oestrogen can be given alone since endometrial cancer is no longer a possible side effect. Otherwise a combination of oestrogen and progesterone are usually chosen since oestrogen given alone carries a greater risk of endometrial cancer. Testosterone, so often forgotten, can now be given alone or in combination with either of the other hormones.

What are the treatments for menopause?

The most effective treatment for menopausal symptoms remains hormone replacement therapy. If you have not had a hysterectomy this will involve a combination of oestrogen and progesterone and perhaps testosterone. If you have had a hysterectomy, because that removes the danger of endometrial cancer, the estrogens alone or in combination with testosterone, will be your treatment of choice.

In 2002 the preliminary findings of the Women’s Health Initiative study were reported to a fanfare of alarming publicity. The bottom line was often misinterpreted in attention grabbing headlines like: HRT CAUSES BREAST CANCER.   However, it might be useful to understand exactly what the study did in fact report:

Among 10,000 women taking oestrogen/ progesterone combination HRT for one year there were eight extra cases of breast cancers when compared to a similar group of women not receiving HRT over one year. The initial study did not show any extra deaths among the HRT taking women.

Other facts that sometimes hysterical reports on this study failed to mention was that there was a decreased incidence of bone fracture and of bowel cancer among the HRT group. And also there was a 15% reduction in the incidence of breast cancer among women who were on oestrogen only HRT – that is, post-hysterectomy women.  

There were 38 cases of breast cancers among the HRT group compared to just 30 cases among the non HRT group. The question then that a woman needs to ask herself is this. Are the benefits of my taking HRT such that they outweigh the increase in the risk of developing breast cancer? This question needs to be answered in the calm light of day and not be unduly influenced by devotees on either side. Is the risk versus benefit ratio correct? Are my menopausal symptoms such that to be rid of them would be well worth the risk of being one of those 8 in 10,000 women for whom this treatment might cause breast cancer?

To add even more worry to this vexed question The Women’s Health Institute study also showed an increased risk of developing heart attach and stroke among the HRT group of approximately the same increased rate of some 10 extra women per 10,000 on treatment. Again this figure needs to be looked at in a balanced fashion for what it is and risk/benefit ratio needs to be weighed up.  

What about Natural or Bioidentical HRT.

Much play has been made in recent years about the virtues of naturally occurring hormones as distinct from the synthetic ones. Indeed a major industry has grown up around this very topic. Some very fashionable and famous women have thrown themselves behind the argument in favour of “naturally occurring” HRT. Unfortunately though, this is invariably accompanies by far more hyperbolae than clinically proven fact, anecdote rather than study.  The problem is, search as you may, there are no published studies that I am aware of, that actually prove that naturally occurring hormones impart any benefit over the synthetic ones and may do not carry the same efficacy.

Summary.

Hormone replacement therapy (HRT) for women today remains every bit as valid and as useful as it always has been. It has now been extended to considering the addition of testosterone to oestrogen and progesterone. As always, care must be exercised and this therapy should only be embarked upon under medical supervision and advice. In our present knowledge so called “Bioidentical” HRT offers no advantage over their synthetic equivalents and indeed may not be as effective.   

Article by Doctor Rynne: http://www.doctorrynne.com/