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
