Hormone Replacement Therapy – Study Comments
April 12, 2011 by Dr. Marc Darrow, M.D.
Filed under Hormone Supplementation
Researchers writing in the Journal of the British Menopause Society say “Many women have been denied or have discontinued HRT because of the fear of risks, which may not have been put in perspective or fully understood.”
Davey DA. Hormone replacement therapy: time to move on? J Br Menopause Soc. 2006 Jun;12(2):75-80.
Hormone replacement therapy: time to move on?
The risks and benefits of hormone replacement therapy (HRT) need to be put in perspective. In the analysis of clinical trials, emphasis is often placed on relative risks, statistical significance and 95% confidence intervals, whereas, from a clinical perspective, more may be gained from a consideration of the absolute and attributable risks of therapy.
The Council for International Organizations of Medical Sciences recommended that the frequency of adverse events be categorized as ‘rare’ if less than 1/1000 but more than 1/10,000, and as ‘very rare’ if less than 1/10,000. In the analyses of the Women’s Health Initiative (WHI), the attributable risks were ‘appreciable’ (i.e. more than 1/1000) only in women aged over 70 years, with the exception of the risks of venous thromboembolism and stroke. The women in the WHI trial do not represent the relatively younger, healthy, postmenopausal women most commonly prescribed HRT, who are probably at much lower risk.
Moreover, the WHI trial did not take into account the benefit of relief of menopausal symptoms, which is, for many women, paramount and outweighs the ‘rare’ long-term risks. Age may be a useful guide to risks and some simple guidelines for management, based on age, are suggested. Many women have been denied or have discontinued HRT because of the fear of risks, which may not have been put in perspective or fully understood. The care of postmenopausal women is not static, and sufficient has now been learned to enable each menopausal woman, with the help of her medical adviser, to come to a balanced and reasonable decision.
In the News
April 12, 2011 by Dr. Marc Darrow, M.D.
Filed under In the News
Walking off Postmenopausal decreases in bone mineral density, aerobic fitness, muscle strength, and balance. Researchers writing in the medical journal Physical Therapy say that “Menopause may induce a phase of rapid decreases in bone mineral density, aerobic fitness, muscle strength, and balance, especially in sedentary women. The purpose of this study was to examine the effects and feasibility of an exercise program of 1 or 2 bouts of walking and resistance training on lower-extremity muscle strength (the force-generating capacity of muscle), balance, and walking performance in women who recently went through menopause.”
Read more
From our last issue…
Men and Testosterone More Body Mass…Diminished Testosterone
Researchers writing in the medical journal Archives of Andrology say total testosterone and SHBG concentrations proportionally diminished with both the increase of BMI (body mass index) and insulin resistance index. Read more
Intimate Activity and Level of Satisfaction in Middle Aged and Older Women
Researchers writing in the medical journal Obstetrics & Gynecology looked at women aged 40-69 for their levels of intimate activity and satisfaction, see what they found.
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Hormones, Oxidative Stress, Menopause
April 12, 2011 by Dr. Marc Darrow, M.D.
Filed under Menopause
In the News…
Researchers writing in Clinica Chimica Acta, the International Journal of Clinical Chemistry and Applied Molecular Biology suggest that Hormone Replacement therapy may play a beneficial role in the protection against oxidative stress.
Clin Chim Acta. 2006 Jul;369(1):73-7. Epub 2006 Feb 10.
Unfer TC, Conterato GM, da Silva JC, Duarte MM, Emanuelli T. Influence of hormone replacement therapy on blood antioxidant enzymes in menopausal women. Clin Chim Acta. 2006 Jul;369(1):73-7. Epub 2006 Feb 10.
From the abstract:
BACKGROUND: Natural loss of estrogen occurring in menopausal process may contribute to various health problems many of them possibly related to oxidative stress. Hormone replacement therapy (HRT) is the most common treatment to attenuate menopausal disturbances. This study was aimed at evaluating the influence of HRT on the activity of antioxidant enzymes (superoxide dismutase, SOD; catalase, CAT; and glutathione peroxidase, GPx) and lipid peroxidation (thiobarbituric acid reactive substances, TBARS) in menopausal women.
CONCLUSIONS: HRT antagonizes the decrease of SOD activity that occurs after menopause, suggesting that HRT may play a beneficial role in the protection against oxidative stress.
Related links
Estrogen Selected Research
More Estrogen Links
Breast Cancer and Estrogen Replacement Therapy
What Effects Does Estrogen Have On The Skin?
Estrogen and Sun Damaged Skin
Women With Higher Levels of Estrogen Have Prettier Faces
Menopause and Heart Disease
April 12, 2011 by Dr. Marc Darrow, M.D.
Filed under Menopause
Researchers writing in the medical journal Climacteric say that “an ideal hormone replacement therapy that can overcome hypertension, prevent body weight gain and control serum triglycerides offers an important advance in cardiovascular risk management during the menopause.”
Rosano GM, Vitale C, Tulli A. Managing cardiovascular risk in menopausal women.Rosano GM, Vitale C, Tulli A. Climacteric. 2006 Sep;9(5):19-27
From the article abstract:
“Blood pressure control and prevention of glucose intolerance are primary factors in overcoming the increased cardiovascular risks in menopausal women.
This heightened risk may partially be explained by the metabolic syndrome – a precursor of type 2 diabetes – in which the renin-angiotensin-aldosterone system may play a pivotal role.
Once diabetes occurs, the cardiovascular risk is considerably greater in postmenopausal women than in men – especially if hypertension is also present.
An additional risk factor, weight gain, is common in postmenopausal women not treated with hormone replacement therapy.
Rigorous control of blood pressure has been shown to be particularly beneficial in women with metabolic syndrome; a reduction in blood pressure can reduce the mortality rate of ischemic stroke.
The administration of hormone replacement therapy can also reduce the likelihood of coronary heart disease in postmenopausal women; therefore therapy should be started early in the menopausal transition to maximize cardiovascular protection. As such, an ideal hormone replacement therapy that can overcome hypertension, prevent body weight gain and control serum triglycerides offers an important advance in cardiovascular risk management during the menopause.”
Hot Flashes and Sleep
April 12, 2011 by Dr. Marc Darrow, M.D.
Filed under Menopause
Researchers writing in the medical journal Menopause say that ambient temperature and REM sleep patterns effect sleep in postmenopausal women.
Freedman RR, Roehrs TA.Effects of REM sleep and ambient temperature on hot flash-induced sleep disturbance. Menopause. 2006 Jul-Aug;13(4):576-83.
From the study abstract:
OBJECTIVE:: To determine whether hot flashes produce sleep disturbance in postmenopausal women.
DESIGN:: This study was performed in a university medical center laboratory with 18 postmenopausal women with hot flashes, six with no hot flashes, and 12 cycling women, all healthy and medication free. Polysomnography, skin and rectal temperatures, and skin conductance to detect hot flashes were recorded for four nights.
Nights 2, 3, and 4 were run at 30 degrees C (86 degrees F), 23 degrees C (about 73.5 degrees F), and 18 degrees C (about 64.5 degrees F) in randomized order.
RESULTS:: During the first half of the night, the women with hot flashes had significantly more arousals and awakenings than the other two groups and the 18 degrees C ambient temperature (about 64.5 degrees F) significantly reduced the number of hot flashes.
These effects did not occur in the second half of the night. In the first half of the night, most hot flashes preceded arousals and awakenings. In the second half, this pattern was reversed.
CONCLUSIONS: In the second half of the night, rapid eye movement sleep suppresses hot flashes and associated arousals and awakenings. This may explain previous discrepancies between self-reported and laboratory-reported data in postmenopausal women with hot flashes.
Hot Flashes and Insomnia
April 12, 2011 by Dr. Marc Darrow, M.D.
Filed under Menopause
Researchers writing in the Archives of Internal Medicine say: “Severe hot flashes are strongly associated with chronic insomnia in midlife women. The presence of hot flashes should be systematically investigated in women with insomnia. Treating hot flashes could improve sleep quality and minimize the deleterious consequences of chronic insomnia.”
Ohayon MM. Severe hot flashes are associated with chronic insomnia. Arch Intern Med. 2006 Jun 26;166(12):1262-8
BACKGROUND: Because hot flashes can occur during the night, their presence has been frequently associated with insomnia in women with symptoms of menopause. However, many factors other than hot flashes or menopause can be responsible for insomnia, and several factors associated with insomnia in the general population are also commonly observed in perimenopausal and postmenopausal women who have hot flashes.
METHODS: A random sample of 3243 subjects (aged >/=18 years) representative of the California population was interviewed by telephone. Included were 982 women aged 35 to 65 years. Women were divided into 3 groups according to menopausal status: premenopause (57.2%), perimenopause (22.3%), and postmenopause (20.5%). Hot flashes were counted if they were present for at least 3 days per week during the last month and were classified as mild, moderate, or severe according to their effect on daily functioning.
Chronic insomnia was defined as global sleep dissatisfaction, difficulty initiating sleep, difficulty maintaining sleep, or nonrestorative sleep, for at least 6 months. Diagnoses of insomnia were assessed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, classification.
RESULTS: Prevalence of hot flashes was 12.5% in premenopause, 79.0% in perimenopause, and 39.3% in postmenopause. Prevalence of chronic insomnia was reported as 36.5% in premenopause, 56.6% in perimenopause, and 50.7% in postmenopause.
Prevalence of symptoms of chronic insomnia increased with the severity of hot flashes, reaching more than 80% in perimenopausal women and postmenopausal women who had severe hot flashes. In multivariate analyses, severe hot flashes were significantly associated with symptoms and a diagnosis of chronic insomnia. Poor health, chronic pain, and sleep apnea were other significant factors associated with chronic insomnia.
CONCLUSIONS: Severe hot flashes are strongly associated with chronic insomnia in midlife women. The presence of hot flashes should be systematically investigated in women with insomnia. Treating hot flashes could improve sleep quality and minimize the deleterious consequences of chronic insomnia.
Maintaining Muscle Strength May Counteract Postmenopausal Bone Loss
April 12, 2011 by Dr. Marc Darrow, M.D.
Filed under Menopause
Sirola J, Rikkonen T, Tuppurainen M, Honkanen R, Jurvelin JS, Kroger H. Maintenance of muscle strength may counteract weight-loss-related postmenopausal bone loss-a population-based approach. Osteoporos Int. 2006 Feb 21.
Researchers writing in the medical journal Osteoporosis International say that maintaining muscle strength may counteract postmenopausal bone loss related to weight loss and that exercise that improves muscle strength may be encouraged for postmenopausal women with weight loss intentions for other health reasons.
From the study abstract:
INTRODUCTION: “Weight loss significantly increases postmenopausal bone loss, but the effects of muscle strength change on weight-loss-associated bone loss remain unclear. The study population, 587 peri- and postmenopausal women, was a random sample of the original Osteoporosis Risk Factor and Prevention Study (OSTPRE) study cohort in Kuopio, Finland.
Bone mineral density (BMD) at the lumbar spine (LS) and femoral neck (FN) was measured with dual x-ray absorptiometry, and grip strength was measured with a pneumatic squeeze dynamometer at baseline in 1989-1991 and at the 10-year follow-up in 1999-2001.
METHODS: Women were divided into three groups according to change in age-grouped grip-strength quartile in both of the measurements: “decreased”, “maintained” , and “improved”.
In addition, the study sample was divided into two groups according to weight change during the follow-up: weight losers and weight gainers.
RESULTS: There were no differences in the change status of grip (muscle) strength between the weight loss and weight gain groups.
Women losing weight during the follow-up and within the improved grip-strength-change group had a significantly lower bone loss rate compared with those in the maintained and decreased grip-strength-change groups.
This was in contrast to women who gained weight during the follow-up (not significant between any grip-strength-change groups). Furthermore, women who lost body weight and were in the improved grip-strength-change group had a bone loss rate comparable with that of the women who gained body weight (not significant).
CONCLUSION: The present study suggests that maintaining muscle strength may counteract postmenopausal bone loss related to weight loss. Accordingly, exercise that improves muscle strength may be encouraged for postmenopausal women with weight loss intentions for other health reasons.”
Menopause and Peri-Menopause Blog
April 12, 2011 by Dr. Marc Darrow, M.D.
Filed under Menopause
Question from Radio Show Caller
Caller: I entered menopause or peri-menopause just a few years ago, I found some things that worked for me, and now they are no longer working even though I am on bio-identical hormones. I started having the nights sweats, the fatigue, moodiness and things like that. I have tried several estrogens and several different things. So far, no luck, meaning I am experiencing those symptoms still, and I have occasional periods. What do I do?
Dr. Darrow: You need to get your hormone levels checked. If you have occasional periods then you are still peri-menopausal, which is the most difficult phase, because at that stage your ovaries are erratically putting out different amounts of hormones, it is very tough at that stage to really get someone on track.
Progesterone is probably the most important thing that you can have in your system because it is a relaxant, it modulates the amount of estrogen so you don’t get it too high, like those months that you are flaring with estrogen and probably moody and feeling a little bit out of whack and retaining fluids, etc.
The way I like people to take Progesterone is by pill just before they go to sleep, I give it to men and women. For women, it is the most relaxing of all the hormones, it also helps build bone. I don’t know if you had a bone densitometry taken recently but it is something that is very important, if you need one you can always call our clinic because that tells the tale right there if you have enough estrogen, testosterone and progesterone because those hormones build up the bone structure, it is most important to maintain the bones, because if the bones are demineralizing, there is a risk of fracture.
You need to have your hormone levels checked. You also need to have very adequate levels of testosterone, not the levels that a man has, but the upper levels that a strong young women has and if you are peri-menopausal, I am not sure how old you are.
Caller: I am 54
Dr. Darrow: Then your Testosterone level has probably dropped down to nothing, it does for most women, and that, in it of itself, once supplemented, can bring you back into alignment. It is also good for the libido and quality of life and the ability to accomplish things.
Estrogen Selected Research
April 12, 2011 by Dr. Marc Darrow, M.D.
Filed under Estrogen
Estrogen and Women’s Heart Disease
Grodstein F, Stampfer MJ. Estrogen for women at varying risk of coronary disease. Maturitas 1998;30:19-26.
Study: Researchers cited that estrogen was beneficial for heart disease risk. “However, few studies have assessed the impact of estrogen use among women with a distinctly higher cardiovascular risk.”
The researchers stated: “Analysis of the effect of estrogen within different risk factor categories in the 16-year follow up of the Nurses’ Health Study confirms that although relevant risk estimates are highly similar, the magnitude of the protective effect of estrogen is more pronounced among women with high baseline risk of disease.”
Estrogen, Depression, and Blood Pressure
Canada SA, Hofkamp M, Gall EP, et al. Estrogen replacement therapy, subsyndromal depression, and orthostatic blood pressure regulation. Behav Med. 2003;29:101-106.
Study: From the abstract: “Although estrogen replacement therapy (ERT) alleviates depressed moods in postmenopausal women, it is not known whether ERT is equally effective in reducing affective and somatic depressive complaints. One of the authors’ goals in this study was to examine possible differences between women receiving and not receiving ERT.”
The researchers stated: “The authors studied a group of postmenopausal women. Somatic symptoms in the ERT group were significantly lower than in the Non-ERT group. Affective scores were only marginally lower in the ERT group…In response to orthostatic challenge, the change in systolic blood pressure was significantly smaller in the ERT group. Apparently ERT is associated with more effective blood pressure regulation.”
Breast Cancer and Estrogen Replacement Therapy
Researchers writing in the August 6, 2005 edition of the British Medical Journal say maybe the risk of developing breast cancer from estrogen replacement therapy is not as great as everyone thought.
The researchers noted that estrogen therapy accounted for eight additional cases out of 10,000 women.
In 2002, headlines cited that researchers discovered that estrogen therapy could double the risk for getting breast cancer.Read abstract
Estrogen and Physical Appearance
Women With Higher Levels of Estrogen Have Prettier Faces
Researchers at the University of St. Andrews in Scotland announced that women who had higher amounts of estrogen in their urine were found to be more attractive than women who had lesser amounts.
What Effects Does Estrogen Have On The Skin?
Researchers have found that “Estrogen loss at menopause has a profound influence on skin.” Writing in the medical journal Climacteric, study authors noted, “Estrogen treatment in postmenopausal women has been repeatedly shown to increase collagen content, dermal thickness and elasticity, and data on the effect of estrogen on skin water content are also promising.”
Hormone Replacement Therapy and Possible Cardiovascular Benefits in Women
Researchers writing in the medical journal Climacteric say that “Women who receive 2-3 years of HRT after menopause do not have increased all-cause mortality, and results of the present study suggest relative cardiovascular benefits compared to those who had not used hormones.” Read more
Estrogen and Sun Damaged Skin
Researchers at the University of Michigan Department of Dermatology are currently recruiting subjects to participate in a study to test Estrogen’s effect on the skin.
Risk of stroke and hormone replacement therapy
Researchers writing in the medical journal Maturitas say that there is no significant association between hormone therapy and risk of total stroke in women during 10.5 years follow-up.
Postmenopause and periodontal disease
A recent study in the Journal of Periodontology says that in an 11.7 year follow up, 57.5 percent of women lost at least one tooth after menopause.
Synthetic Hormone Replacement—Fact and Fiction
April 12, 2011 by Dr. Marc Darrow, M.D.
Filed under Hormone Supplementation
One of the things our media is very good at is blowing a story way out of proportion at the expense of presenting all the facts. So it was with the world-wide reporting of the dangers of Hormone Replacement Therapy in the aftermath of the JAMA article. News reports circled the globe in nearly every news outlet, that a protocol taken by millions and millions of women in the United States, estrogen and progestin, when taken in combination, greatly increased the chances of serious health problems and even death.
As part of the Woman’s Health Initiative (WHI), a very large scale study which sought to examine potential health strategies to “reduce the incidence of heart disease, breast and colorectal cancer, and fractures in postmenopausal women,” researchers studied the effects of Hormone Replacement Therapy, (Estrogen and Progestin). Originally designed as an eight year study, the study was halted three years early when the researchers accumulating their findings and discovered that HRT was responsible for increases in incidences of breast cancer, heart attack, stroke, and blood clots in the lungs (pulmonary embolism) and legs (deep venous thrombosis).
What the media failed to mention was that taking estrogen in a synthesized version, distilled from pregnant horse urine plus a synthetic progestin, when taken in combination, greatly increased the chances of developing breast cancer, heart disease, strokes and blood clots. So instead of saying the drug Prempro (an estrogen-plus-progestin therapy) was found to cause a greater incidence and certain cancers, it was Estrogen and Progestin! (In the section about Progesterone, read about the differences between Progestin and the naturally occurring Progesterone).
Bio-identical Hormones
Years before the risks of synthetic hormone replacement therapy was made known, medical pioneers such as New York Times best-selling author John Lee, M.D., spoke out about these very same dangers, in his book What your Doctor May Not Be Telling You About Menopause. Dr. Lee says quite plainly “(there are…) reams of evidence that synthetic estrogens are highly toxic and carcinogenic.”
Dr. Lee and others took a skeptical view of the pharmaceutical industry that pushed synthetic hormones, because they are produced by companies who hold exclusive patents on these drugs and as such make billions of dollars. Bio-identical hormones are not patentable and are therefore incapable of being a huge profit maker.
What are Bio-identical hormones?
As mentioned earlier, bio-identical hormones are not “Natural Hormones,” even though they are derived from plants such as the Wild Yam and soy plants. During the process to convert plant derivatives to bio-identical hormones, a chemical or synthesizing process must be performed to the highest standards by a reputable laboratory.
The synthesized product becomes a bio-identical hormone, a product whose molecular structure exactly matches that of human hormones and is processed by the human body as a “naturally” occurring hormone.
The difference between synthetic estrogen and the body’s own hormones stresses the difference between synthetic and bio-identical hormones. Synthetic estrogen derived from horses contains 30 or 40 different estrogens types that a horse needs, but a human female does not. The human female only produces estrone (E1), Estradiol (E2), & Estriol (E3). Bio-identical hormones replicate the human estrogens.
But I thought no hormone replacement therapy was safe!
Opponents of bio-identical hormones point out that there are no long-term studies that show bio-identical hormones are any safer than the synthetic hormones.
Bio-identical hormones should be prescribed in the smallest dose possible to restore the body to its natural level of hormone. Regular blood or saliva or urine level monitoring and physical examination will help the physician administer the right dosage for each woman.
Selected Research
The Estrogen Controversy
Harman SM, Anatolian F, Brinton EA, Judelson DR. Is the Estrogen Controversy Over? Deconstructing the Women’s Health Initiative Study: A Critical Evaluation of the Evidence. Ann. N.Y. Acad. Sci. 1052: 43–56 (2005).
From the article abstract: The Women’s Health Initiative (WHI) hormone trials have been widely interpreted as demonstrating that combined menopausal hormone therapy (HT) fails to protect against—and may increase—cardiovascular disease (CVD), stroke, and dementia in menopausal women, regardless of whether initiated early in the menopause or later. This conclusion does not agree with results of large epidemiological studies showing protection by HT and by estrogen replacement alone (ET) against CVD and dementia. One possible reason for this inconsistency is that the epidemiologic data are confounded by “healthy user bias.” Another possible explanation is that most women in the observational studies initiated ET or HT at or near the menopausal transition, at which point there is little or no arterial injury, whereas, in the WHI studies, older women, averaging approximately 12 years postmenopausal, many of whom would have had significant asymptomatic atherosclerosis, were treated. Substantial data demonstrate atheropreventive effects of estrogen before vascular damage occurs, whereas adverse effects of oral estrogen on thrombosis and inflammation may predominate once complex atheromas are present. Similarly, the excess of dementia observed in older WHI women treated with oral conjugated estrogen could be due to cerebral thromboses (multi infarct dementia). Given the uncertain relevance of the WHI (and other published randomized clinical trials) to initiation of HT in perimenopausal women, and its subsequent continuation for atheroprevention, new trials will be needed to resolve whether early intervention with estrogen may prevent CVD and/or dementia. The Kronos Early Estrogen Prevention Study (KEEPS), which began in mid 2005, is a randomized, controlled multicenter trial of HT in recently menopausal women. It will examine surrogate end points as well as risk factors for atherosclerosis.
Estrogen for Bone Density/Osteoporosis
Lafferty FW, Fiske ME. Postmenopausal estrogen replacement: A long-term cohort study. Am J Med 1994;1:66-77.
Study: A long-term study to determine the success of estrogen replacement in bone loss.
The researchers stated: “The mean cortical bone density at the distal third of the radius was significantly greater among the ERT subjects compared to the control subjects with the difference representing a 12.0% higher bone density with ERT.”
Estrogen for Cognition
Greene RA, Dixon W. The role of reproductive hormones in maintaining cognition. Obstet Gynecol Clin North Am. 2002;29:437-453.
Study: The researchers sought to show the relationship between hormones and cognition citing that “Estrogen has the most profound impact on brain functioning. ”
The researchers stated: “Although skeptics may believe that more definitive proof is necessary before recommending hormone replacement for their patients to preserve their cognitive health, it seems prudent to discuss the evidence available to empower the patient further to guide their own treatment options and validate their symptoms.
Postmenopause, periodontal disease and estrogen
A recent study in the Journal of Periodontology says that in an 11.7 year follow up, 57.5 percent of women lost at least one tooth after menopause. Bone loss is to blame!
The American Academy of Periodontology’s press release on ths study says “Estrogen deficiency after menopause and consequent loss of bone mineral density have been shown to be associated with increased rate of tooth loss. These relationships may be explained by increased severity of periodontal disease in estrogen deficiency.”
Click here to read the abstract
Click here for the press release
More research in segment 3