Hormone Replacement: How to Balance Your Hormones Naturally. Dr. Cabot Sandra

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СКАЧАТЬ the hallmark of the beginning of ageing. Yes, we are truly fortunate to be living in this day and age!

      The Modern-day Controversy about Hormones

      Before the results of the Women’s Health Initiative (WHI) Study were published in August 2002, millions of women in the UK, US and Australia were using some type of HRT.

      The use of non-hormonal alternatives for the menopause has also increased. It is true that drug companies have a vested interest in the lucrative baby-boomer generation of women, and it is true that women also have a big interest in a type of HRT that will promise them a better quality of life. However, the baby-boomer generation of women is well educated and discerning, and wants to know the real facts.

      Thus, the results of the WHI Study on the effects of combined oral HRT on 16,000-plus women was very timely, and have proven to be a defining moment in medical history that could be considered a bombshell for many researchers in the field of HRT.

      The Study uncovered some alarming findings that obviously worry doctors and consumers of HRT. The data and safety monitoring board recommended stopping this trial prematurely because women receiving the active hormones had an increased risk of invasive breast cancer, and an overall measure suggested that the HRT was causing more harm than good. The decision to abandon the trial occurred after an average follow-up period of 5.2 years, although the trial was originally planned to continue for 8.5 years. There were other outcomes that suggested danger, such as an increased risk of coronary heart disease and pulmonary embolism.

      Overall, the results of the WHI Study confirmed the growing body of evidence that combination oestrogen/progestin tablets can increase the risk of breast cancer with increasing duration of use, and increase the risk of stroke and blood clots during five years of use. The increased risk of coronary heart disease was largely found during the first year of HRT use. Overall, this American study found that women on combined oestrogen and progestin tablets had a 26 per cent increased relative risk of developing breast cancer, a 29 per cent increase in heart disease, and were 41 per cent more likely to have a stroke. Most of these problems began appearing within the first one to two years of HRT use, but the increased breast cancer risk did not begin until three years of use.

      Positive effects of the combined HRT regime were a reduction in the risk of bowel cancer and bone fractures.

      In terms of absolute risk, the above figures can be translated into the following statistics – if 10,000 women take combination oral HRT for one year, eight more will get invasive breast cancer, seven more will have heart attacks, eight more will have strokes, and eight more will have blood clots, compared to a similar group of women not taking the hormones. On the plus side, there will be six fewer cases of bowel cancer and five fewer hip fractures.

      You can see from these absolute risks of harm, when we look at 10,000 women taking HRT for one year, the risk to an individual woman is not great. However, if we count all the adverse health events that happened over the 5.2 years of the WHI Study, the excess number of adverse events in the women using the HRT was 1 in 100 women. This is a small risk, but shows that risks from combined oral HRT add up over time.

      Although the WHI Study was set up originally to demonstrate the ability of HRT to prevent common diseases of ageing, the Study found that the opposite effect appeared to be happening. Given these results, the authors of the Study are recommending that doctors stop prescribing combined oral HRT therapy for long-term use.

      Since the results of the WHI Study have caused such a furore, many people are asking questions that will take time to answer definitively – it is possible that future studies will find that the benefits outweigh the risks, perhaps thorugh the use of different combinations or formulations of more natural hormones. For example, studies are needed to determine the long-term benefits of transdermal natural hormones provided as patches or creams. I am confident that these will be shown to be safer than oral combined synthetic HRT, but only time will tell.

      Professor Graham Colditz from Harvard Medical School was refreshingly candid about the results of the WHI Study: he said they are a major wake-up call to both consumers and health authorities. Since the WHI Study was abandoned, Professor Colditz and many other health experts around the world no longer recommend the use of long-term combined oral HRT to prevent disease. However, the use of combined oral HRT is still considered as generally safe when used for short-term treatment to relieve menopausal symptoms. My attitude to this is – Why would you use oral synthetic hormones when you have natural hormones that can be given in a more physiological way to relieve the symptoms of menopause?

      The results of the WHI Study were based upon using 0.625 mg of Premarin (conjugated equine oestrogen) plus 2.5 mg of Provera (medroxyprogesterone acetate). Other types of oral hormone combinations may have different results. However, three studies using other oral combinations of HRT have all found an increased risk of breast cancer. An Oxford University Study in the mid-90s showed that oral HRT increased the risk of deep vein thrombosis. A long-term study of nurses found a link with breast cancer in 1995, but until now, the risk of combined oral HRT has generally been kept rather low key in mainstream medicine. Well, we have known for years that oral oestrogens such as Premarin, if taken for more than five years, will increase the risk of breast cancer by around 30 per cent. So why has the outcome of the WHI Study created such a bombshell?

      It could be partly because the experts cannot seem to agree on the significance of the findings of the WHI Study –

      Dr Deborah Grady, Director of the Mount Zion Women’s Health Clinical Research Center at UCLA (University of California in Los Angeles), believes that the results of the WHI Study provide compelling evidence that doctors find a way to get women off oestrogen.

      Dr Maura Quinlan, an HRT specialist at the University of Chicago Hospitals, states ‘We have to stop using HRT for healthy women.’

      Dr David Dammery, a GP and chairman of the Victorian College of General Practitioners in Australia, is very much against HRT for long-term prevention.

      Other well-known professors world-wide believe that the design of the WHI Study was flawed, and that its results are not representative of the true value of HRT in healthy menopausal women. They criticize the sample of women chosen in the WHI Study as being unsuitable candidates for the use of HRT in the prevention of cardiovascular disease. They cite the problem that the sample of women chosen was too old and unhealthy to be used in a primary-prevention trial of the benefits of HRT.

      Indeed, 66 per cent of the women in the WHI Study were 60 years or older. One-third of women in the study sample were obese, 36 per cent were being treated for high blood pressure, 12.5 per cent were being treated for high cholesterol, and 50 per cent were ex-smokers. Thus they were not representative of healthy women who had just arrived at menopause. According to these experts, the results of the WHI Study are not meaningful for healthy post-menopausal women. They also point out that there was no increased death rate among the women in the WHI Study who took HRT, compared to those who did not.

      What Are the Real Issues?

      As a doctor who sees thousands of peri-menopausal women, I believe that it is the quality of life now, and in the immediate future, that is most important to women. This is what women grapple with every day, and it greatly affects the enjoyment of their lives.

      Just because certain types of hormones have been found to be unacceptably dangerous for long-term use, does not take away the need for, and interest in, hormone replacement therapy. Women are not so much interested in how they will feel in 20 or 30 years’ time, but rather want to be able to enjoy the still relatively young years, at least in today’s terms, that exist between the ages of 45 to 65. Also, today’s woman is smart and well educated and wants to know ALL her options. She knows that СКАЧАТЬ