Dr. Cutler believes this is not only unwise, it's an incorrect assumption. "Panic trumped good science."
I happen to have a very savvy physician who is a national expert on menopause and women's health. We've discussed at length the whole hormone issue and how the results of the WHI (the Women's Health Initiative) were misinterpreted, which basically brought the use of hormone replacement therapy to a screeching halt.
I read the results and the interpretations of the WHI study in the medical journals for myself, and together with my doctor's advice I made the completely radical & unorthodox decision to start hormone replacement therapy even though I didn't have any "intolerable" menopausal symptoms--which post-WHI, is the only reason to start HRT.
Full Disclosure Here: I decided to take HRT for prevention--and because I knew from the literature, and the WHI, that if one wanted to receive any of the benefits of hormone replacement--like prevention of osteoporosis, urogenital health, possible brain health & flexible blood vessels--there is just a small window of opportunity when you can begin HRT. If you wait too long after menopause to start, once blood vessels start to stiffen, you could put yourself at risk for adverse cardiovascular effects.
But I wasn't about to take Premarin, the equine-derived estrogen or a synthetic progestin like Provero or the combination of the two, called Prempro. Let's just say, these are the synthetic hormones that were probably responsible for some of the adverse results of the WHI.
Together, we decided upon a regimen that closely duplicates a woman's natural cycle; the daily use of a bio-identical topical estrogen (estradiol-17 beta) cream called Estrasorb; and for 12 days a month--a bio-identical pill form of progesterone, called Prometrium. As time went by--the doses of both of these have been cut in half.
Books and articles cross my desk constantly, but last week when I spotted Hormones and Your Health: The Smart Woman's Guide to Hormonal and Alternative Therapies for Menopause by Winnifred Cutler, I scooped it up and couldn't put it down.
What a find! Finally, a book written in plain language by a biologist who has studied and written extensively about hormones and has reviewed many of the studies on the subject. Cutler studied over 3,000 peer-reviewed articles--and she cites 880 of them in her book.
I've reserved a copy at my local library and I can't wait to read the entire book. Dr. Cutler certainly has the credentials and background to write such a book, and she has no vested interest in selling hormones, no pharmaceutical research funding, or hidden agenda.
Be sure to read Stephanie Young's interview with Dr. Winnifred Cutler, "The Other Side of the Hormone Controver--A New Argument for Hormones" in More magazine, April, 2009. Click here.
A Study You Should Know About But May Not: KEEPS is an ongoing study--"Kronos Early Estrogen Prevention Study"--which aims to study what the WHI did not. Can HRT prevent cardiovascular disease (atherosclerosis in particular) in women, if it's given early--immediately after menopause. Unlike the WHI, it's comparing a bio-identical estrogen/progesterone combo with the synthetic Premarin. Many researchers feel that bio-identical hormones given transdermally & right after menopause will make all the difference. For more click here.
In other words--it's the study that's answering the questions that the WHI did not.
Here are a few highlights from "Hormones for Your Health":
1. How hormones got a bad name from the WHI study
- One result cannot be applied to all. Dr. Fred Naftolin, an eminent biomedical scholar at Yale has said the "WHI has been inappropriately used to create guidelines (for physicians) that are incorrect for any group other than the overweight, average-seventeen-years-postmenopausal population on which the particular regimen (synthetic Premarin, Provera or Prempro) was tested."
- The study participants weren't particularly "healthy". "The WHI participants ranged in weight from simply overweight to frankly obese, with an unusually high incidence of arterial hypertension and a high prescription drug use to control other conditions. Nearly 50% of the study population started out with several serious cardiovascular risk factors."
- The WHI was not a preventive study. The WHI, contrary to its claims, wasn't designed to study "primary prevention"--which is preventing disease in an already healthy population. You can't study "primary prevention" in healthy women when the majority of the women enrolled either already have cardiovascular disease or are at a high risk for getting cardiovascular disease, because they were overweight, well past menopause, & hypertensive.
- Not all progestins and estrogens are alike. Synthetic progestins (medroxyprogesterone acetate-generic Provero) affect the body differently than bio-identical progesterone. Research has long shown adverse cardiovascular effects from the synthetic form. The bio-identical variety is also dosed in a cycle that is similar to a woman's natural cycle--taken only 12 days a month. Transdermal (topical) estrogen has a more favorable and safer effect than oral forms.
- Decline in bone quality
- Diminished cardiovascular health
- Urogenital atrophy--atrophy of the urogenital tissues in up to 47% of women.
- Wrinkled skin
- Blood vessel thickening and atherosclerosis
- Cognitive decline
- Increase in fat, decrease in muscle.
- Skin benefits with increased thickness, greater blood flow, faster wound healthing, greater water-holding capacity, less wrinkling
- Healthier vaginal tissues. Responsible for higher acidity which prevents infections; less dryness, less atrophy, less thinning, less urinary tract infections
- Less hot flashes & night sweats
- The nose benefits from estrogen & progesterone. Without hormones the nose is drier, feels stuffier, produces less mucus. Since the nose is the first line of defense against airborne infections, hormone therapy helps the body to fend off colds & flu.
- Estrogen and your voice. There are estrogen receptors in the voice box--women taking HRT had fewer voice complaints, hoarseness, vocal cord dystrophy.
- Estrogen and your teeth. More estrogen--less tooth loss.
- Estrogen and progesterone and your eyes. Hormone users had better vision and fewer eye conditions.
- Estrogen and progesterone and sleep quality. Hormone users had superior sleep quality compared to non-users.
- Estrogen as an antioxidant--lessening the damage of oxygen free radicals that attack the cell membranes of blood vessels.
- Estrogen and gut/intestinal function. Helps the absorption of key minerals, like calcium, and helps to maintain the healthy functioning of the gut
- Estrogen, more positive profile for maintaining stable blood sugar, and preventing type II diabetes.
- Cutler devotes an entire chapter to explaining the entire controversy--how to understand in real numbers the actual risks; why the type of hormones; the kind of dosing & regimen (mimicking a natural cycle); and the method of delivery (oral vs. transdermal) are important to understanding this controversy.
- Breast cancer rates with statin therapy are comparable to breast cancer rates with HRT.
- "Even in the WHI study, the risk of breast cancer on an individual basis was low. In the WHI, of the 8,506 women taking Prempro, 166 cases of invasive breast cancer occurred; in the 8,102 assigned to placebo, 124 cases were detected, that is, 1.95 percent versus 1.53 percent, or a difference of 0.42 percent. So 99 percent of women will not be at increased risk of breast cancer regardless of which hormones they take."
"And remarkably, most studies show that postmenopausal women who develop breast cancer when they are on hormones are less likely to die from it than postmenopausal women who have breast cancer and are not on hormone therapy. This points to the complexity of the relationship between hormones and breast health."
5. Choose Hormones Wisely - What Should You Take?
- Estradiol-17 beta taken transdermally (patch, cream, gel). This mode will not increase triglycerides, and it will enhance heart rate variability.
- Bio-identical progesterone like Prometrium taken on a natural cycle of 12 days a month. A sequential regimen lowers the risk of breast cancer, builds better bones, better mental function and a healthier cardiovascular system.
- For urogenital health, consider the ESTring which delivers a very low dose of estrogen (estradiol) at a steady rate locally, not systemically. It's a small flexible ring inserted vaginally. It's an option for women who aren't able to take hormones.
- Estrogen increases the electrical activity of the regions of the brain responsible for verbal and spatial working memory.
- Hormone users perform better in tests of executive function, except when using the synthetic form of progestin (medroxyprogesterone acetate, Provera)
- The brain is receptive to estradiol-17 beta--accept no substitutes.
- Conjugated equine estrogens like Premarin, Prempro or their generic equivalents do not produce the same benefits as the bioidentical estrogen and Cutler believes they may be actually detrimental. Steer clear of synthetic progestins, like Provera or the generic medroxyprogesterone acetate.
- Women who start hormone therapy before age 60 have a significantly better likelihood of enjoying good cardiovascular health.
- The best scores of heart health in the Nurses Health Study were in women using hormones, and who had their uteruses & ovaries intact.
- Once women stopped taking hormones they lost their advantage over "never-users".
- A Swedish study found hormone users had lower triglycerides, lower LDL cholesterol, less obesity, less type-II diabetes, less carotid atherosclerosis and lower risk of developing calcium deposits in the coronary artery.
Obviously, hormone replacement therapy isn't for everyone. It's a decision for both you & your doctor. We're all different, with different risk factors and family histories. Cutler's book advises us to not get so easily scared by the WHI--to not dismiss the hormone option out-of-hand. Read the book--and then make a decision. But remember, there's only a small window of opportunity to start--should you choose to take the HRT route.
Good health isn't found in isolation--with just a pill, a patch or a cream--it must include exercise, a healthy diet, stress reduction, and a healthy lifestyle.