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HRT - Hormone Replacement - A Happy Medium
For those
who have kept current on the medical research findings, the
recent outcry against Premarin and Provera came as no big
surprise. (JAMA 2002; 287: 1923). The media just decided to
put their spin on it as of late. This has caused unnecessary
confusion and anger (possibly danger to life and limb if you
live with a post-menopausal woman who decided to suddenly stop
her Premarin after hearing the news reports). Those affected
know what I mean.
Let’s Gain Perspective
The reason this has had such attention lately is the
Institute of Medicine (IOM) recently cut short a study due to
increased risk of breast/ovarian cancer, strokes, pulmonary
clots, and heart attacks for those using Premarin and Provera.
The risk for the women on Premarin and Provera in the study was
8 out of 10,000 for each of those diseases (JAMA 2002; 288:
321). The research has shown for some time these synthetic
hormones do not appear to be as beneficial as once thought for
prevention of multiple diseases, even though they are often
effective in treating menopausal symptoms.
This brings us to the point of why most women take hormone
replacement therapy (HRT), which is to treat menopausal
symptoms. The severity of menopausal symptoms is influenced by
a woman’s genes and her jeans (the size, that is). As women who
are sedentary, overweight, and eat diets high in refined sugars
are much more likely to have more severe menopausal symptoms and
thus seek pharmaceutical management. These factors also
influence the severity of PMS in pre-menopausal women.
What are my risks?
The risk from hormones comes from the way they are
metabolized, primarily in the liver. Women who metabolize
estrogen through the 2OH pathway are much less likely to get
cancer than those who metabolize estrogen through the 4OH and
16OH pathway (J. Chemical Research Toxicology 1999; 12: 204). A
ratio is calculated by a simple urine test called an Alpha
2OH/16OH ratio. Those with a higher ratio have a 30% lower risk
of breast cancer. Women with a ratio over 2, even if on soy
extracted HRT, are unlikely to get breast cancer (J.
Endocrinology 2001; 170: 165). So as not to leave the guys out,
I would mention the same process is implicated in men with
prostate cancer.
This helps explain why there are so many contradictory studies.
They keep trying to establish risk with which hormones are
given, when it appears the biggest contributing factor is not
just whether a woman takes hormones, but how she individually
metabolizes them. Soy-based hormones are metabolized by the 2OH
pathway (the good one), thus decreasing the risk, whereas
synthetic estrogens like Premarin and Provera, which are
Xenoestrogens, are handled by the liver’s 4OH and 16OH pathways
(the bad ones). So, take a woman who already processes hormones
down the bad pathways, and give her a synthetic Xenoestrogens,
then you may have big problems, where others go unaffected.
What do I do?
In our clinic, we use a soy-extracted hormone mix of
three estrogens (Estradiol, Estrone, Estriol), along with
micronized progesterone, and testosterone. This soy-extracted
mix called 5HRT is supplied in a dissolvable troche placed under
the tongue at bedtime, going right into the blood stream and
bypassing the gut. The 5HRT is calculated in the same
percentage and ratio the body produces them prior to menopause.
We encourage patients to monitor their 2OH/16OH ratio. If it
is abnormal there are supplements to reverse it. (That is
another subject). They then must decide if they want to take
any HRT at all. However, if they do, we insist it be soy-based
5HRT. We have not prescribed synthetic hormones in our office
for 3-5 years, unless a patient demanded it, and then it was at
their own risk.
Happy Medium
Women often feel so much better that they stay on the
5HRT. However, it works very nicely to use for just 6 months or
a year to ease through menopause. The troche’s can be easily
cut in half or quarters, thus making dosage adjustment and
tapering very easy. We can also change the total dosage in the
troche for the individual woman’s needs.
Eat your veggies, do your exercise, take your vitamins and
essential fatty acids, and if you need some HRT, there is a
happy medium.
Jarrod Bagley is
a Family Nurse Practitioner at Pioneer Comprehensive Medical in
Draper. (801) 576-1086 Email- jbagley@pcmclinic.com.
More information is available from Jarrods colleague Dr. Hugo
Rodier. He has a monthly newsletter with the latest research on
health. Call (801) 576-1086 to subscribe or email hrodier@pcmclinic.com.
Author: Jarrod Bagley
Email: jbagley@pcmclinic.com
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