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I recently received a weekly update from one of the services to which I subscribe to keep me up-to-date on current medical practices. The focus of this update was on the treatment of insomnia in menopausal women. It listed various drugs and counseling as the preferred treatment methods. I was surprised and disappointed that a very obvious and effective treatment was missing from the list: Bio-Identical Hormone Therapy. It seems obvious to me that if a person is suffering from insomnia, or any other symptom, related to the sudden decline in reproductive hormones that the solution is to control the decline of said hormones.
Menopause comes with a host of severe symptoms: hot flashes, fatigue, brain fog, insomnia, memory impairment, depression, anxiety, dry skin, vaginal dryness, low libido, thinning hair, osteoporosis, and more. So, why is it not treated more aggressively with hormone therapy in mainstream medicine? Unfortunately, medicine has a way of becoming very convoluted.
In 2002, The Women's Health Initiative, a very large study of the effect of hormones (HRT) on women's health, was halted ahead of schedule due to a dramatic increase in breast cancer and cardiovascular disease in those taking the prescribed hormone therapy. The negative effects were, of course, unexpected and profound. It was assumed a study of this magnitude must have been done appropriately and therefore the results should be considered set in stone. As a result, millions of women were told they could no longer have their HRT medication. The end product resulted in a hot flash that could have melted the polar ice caps.
Fortunately, thoughtful physicians across the word decided to evaluate the data for themselves. Their experience, and common sense, informed them that hormone therapy should not be dangerous. These are hormones that have been in your body for 40-50 years at this point, why would they suddenly become harmful?
Those physicians, with some basic knowledge of hormone therapy and physiology, soon found several profound flaws in the study:
The wrong kind of hormones were used
The hormones used in the study were not bio-identical. They were strong synthetic hormones derived from horse urine call Conjugated Equine Estrogens, and a synthetic form of progesterone call methoxyprogesterone. These synthetic hormones bind to receptors much more powerfully that natural hormones, exaggerating their side-effects.
The wrong delivery method was used
These synthetic hormones were delivered in pill form, instead of transdermally or vaginally, resulting in a first pass through the GI tract and liver. This process especially effects estrogen, making it into a form of estrogen (estradiol-sulfate) that preferentially and unnaturally binds to estrogen receptors in the breast. An ounce of forethought and consideration could have predicted this would not end well - clearly increasing risk for breast cancer.
The dosing method was static
These women received a steady dose of estrogen and progesterone every day, with no cyclic variation. This is an unnatural state for the body as it is accustomed to have a 2 week period of high estrogen, then a 2 week period of high progesterone. There are no studies that tell us how important cycling hormone therapy may be, or what the risks of not cycling while on hormone therapy may be, but common sense tells me that if that is the way the body is used to doing it, we should try to do it that way. Some women no longer wish to cycle and choose static therapy, those should be treated with the lowest dose of estrogen possible.
The women studied were post-menopausal, largely overweight, and heavily populated with smokers.
Interestingly, in order to be included in the study, the women had to be through menopause and asymptomatic. This is not the same group that actually wants and needs HRT. This group was also heavily populated with older, overweight women, with a heavy subpopulation of smokers. Even most lay persons would realize that this is a high-risk group and the data is going to be littered with obesity and smoking related incidents - like cancer and heart disease.
As you can see, there were major flaws in the Women's Health Initiative. It has been 10 years since the study and its effects still weigh heavily on medicine as it is practiced today. Some may ask if the study was so obviously flawed, why do it? The answer is that it is all about the money (surprise!). The study was not intended to show the effects of hormone therapy on women, it was intended to show the effects of a patentable, for-profit, hormone-like drug on women.
Thoughtfully prescribed bio-identical hormone therapy has been prescribed for decades with no noted adverse effects. In fact, recent studies have shown it to have a preventive effect on cancer and heart disease, and no effect at all on blood clotting - the exact opposite of the WHI findings.
Other benefits of bio-identical hormone therapy include:
Near instant elimination of hot flashes
Improved energy and stamina
Increase in lean muscle mass
Increase in metabolism (weight loss)
Younger looking skin and hair
Noticeable slowing of the aging process
What are your options for hormone therapy?
Unfortunately, many medical doctors remain unaware of the flaws of the WHI and are unwilling to prescribe hormone therapy to perimenopausal women. Those that are willing often do not have the necessary knowledge to appropriately prescribe custom compounded hormone therapy and are therefore limited to the narrow pharmaceutical options. The usual prescription is for the Vivelle-Dot, an estrogen only transdermal patch and a micronized progesterone pill. These prescription are OK and work just fine for some women. The dose is very low, usually just enough to take the edge of hot flashes. The prescriptions are usually not covered by insurance and can be quite expensive. For those with minimal symptoms and good insurance coverage, these are good options.
For those doctors with a knowledge of compounded bio-identical hormone therapy, there are unlimited options. The physician can evaluate each case and prescribe and adjust as needed to get optimal results. These prescriptions usually cost between $60-120 per month and are not usually covered by insurance. In addition, doctors may charge extra for these services as they are usually not billable to insurance. For those that have done it, they will tell you it is well worth the minor investment.
In summary, the evidence that HRT is harmful is deeply flawed. Bio-identical hormone replacement therapy is safe, effective, and can give you a whole new lease on life. The key to good hormone therapy is that it should be personalized for your unique needs, delivered as a transdermal or transvaginal cream, should be dosed in a cyclic pattern, and should not include any synthetic hormones.
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