Benefits & Risks of Hormone Replacement Therapy

Benefits & Risks of Hormone Replacement Therapy

There is considerable debate whether or not to treat women in menopause with hormone replacement therapy (HRT). The Women’s Health Initiative has given us new insights on the pros and cons of HRT. What we do know from this study is that estrogen combined with the unnatural progesterone call Provera or medroxyprogesterone, does increase the risk of Alzheimer's disease, heart disease, stroke and breast cancer.

This combination does significantly decrease the risk of osteoporosis and the risk of colon cancer. Estrogen alone, in the form of Premarin (estrogen derived from horse urine), without the addition of Provera, showed no increase in the incidence of breast cancer in this six year study. Long term studies have shown that estrogens prevent heart disease after 5-6 years of treatment.

Short-term hormone replacement therapy increases a woman's blood clotting ability and does increase her risk of heart attack and stroke. Therefore, all women who have risk factors for heart disease or stroke should be screened prior to starting HRT.

We know that estrogen protects women from osteoporosis, colon cancer, and premature atrophy (thinning) of the genitourinary system including the breast. It improves the health of the skin. It certainly reduces menopausal symptoms such as hot flashes and mood swings. Progesterone helps balance estrogen, improves sleep, has a natural calming effect, lowers blood pressure, increases scalp hair, increases metabolic rate, is a natural antidepressant, is anti-inflammatory, lowers cholesterol, stimulates production of new bone , enhances the action of thyroid hormones, improves libido, promotes a healthy immune system and is neuroprotective. Progesterone comes in pill form, sublingual troche, or a cream.

Too much progesterone without adequate estrogen increases weight gain as well as total cholesterol and causes depression, fatigue, decreased libido, elevated cortisol and increased insulin resistance.

Testosterone increases sexual interest, emotional well-being, increases muscle mass and strength, improves memory, helps skin from sagging, decreases excess body fat, helps maintain strong bones and elevates norepinephrine in the brain. Many studies have shown that medroxyprogesterone has negative health consequences in women. It certainly seems logical to use natural progesterone in the treatment of menopause. Natural progesterone is the same chemical structure that is produced by a woman's ovaries and adrenal glands. During pregnancy a woman's progesterone level can rise to 300-400 ng/ml .When treating menopause we usually keep blood levels between 6 and 20 ng/ml. Long-term research on natural progesterone is lacking. Pharmaceutical companies cannot obtain a patent on natural progesterone therefore it is unlikely that a large amount of money will be spent on this compound.

The main objection to hormone replacement therapy is the theoretical increased risk of breast cancer. Most functional medicine physicians believe that the dramatic rise in breast cancer over the past 50 years is due to the toxic environment in which we live. The industrial revolution has led to an unprecedented amount of toxins in our air, water, soil, and food supply. One can decrease this risk by drinking purified water and eating fresh organic foods and minimizing processed foods. Too much stress leads to impaired digestion which in turn leads to nutrient deficiencies and a weakened immune system. High insulin levels are fuel for cancer; therefore all individuals should minimize simple sugars and junk food and engage in routine physical activity. Lactic acid produced from exercise helps remove heavy metals from our body.

Whether or not a woman wants to take HRT is her personal decision. Logic tells me that if a woman is taking hormones and she has side effects such as breast tenderness, increased breast density, or a decreased sense of well-being, she should not be taking hormones. However, if a woman has no increase in breast density or tenderness, and no change in her mammogram and breast examination, and has an improved sense of well-being, I would consider the benefits of HRT over the theoretical risk. I strongly encourage women to have their hormone levels checked at routine intervals and at some point, have a 2-16 estrogen metabolismAquamatic Automatic Cover ratio obtained to further evaluate the risk for breast cancer. I also recommend women not take hormones if her blood tests demonstrate high oxidative stress. Women can decrease there risk of breast cancer by engaging in routine exercise, following a healthy diet, optimize her vitamin D level, and take essential fatty acids such as a omega-3,6 and 9. I recommend a good probiotic taken in the evening. These are healthy germs in a pill that will help aid in detoxification, vitamin production, and support the immune system.

Dr. Cliff Fetters
11900 N. Pennsylvania St. Suite 200
Carmel, IN 46032
Phone: 317-663-7123