Hormone Replacement Therapy (HRT) For Menopause
Some women believe that menopause is a natural event and they do not wish to take hormone replacement (HRT). However in our culture, which eats much chicken and meat (both of which contribute to osteoporosis), a great many women develop osteoporosis once they lose the protective effects of their hormones after menopause. That is, bone loss becomes more rapid after menopause because of the reduction in progesterone and estrogen. Doctors in our culture have learned that women treated at or after menopause with female hormones (estrogen and/or progesterone replacement called "HRT") have less osteoporosis and teeth loss, which are likely caused by our culture's excessive intake of chicken, meat and protein as a whole. There are the "up sides," but the down side of HRT can be a tripling of the risks for the development of Parkinson's Disease, dry eyes, uterine polyps, weight gain, risk of cancer of the breast and/or uterus (if the woman still has her uterus), urinary protein loss (micro-albuminuria), migraine headaches, stroke, clots in the lung (pulmonary emboli), and gall stones.
If you eat a very high fiber, very low fat diet, are lean and trim, do lots of exercise, particularly some weight Iftting using 5 and 10 pound 1 hand hexagonal weights, you are naturally more protected from heart disease, osteoporosis, and tooth loss with an actual decline in cancer of the breast and uterus, gallstones, etc., etc. Walking is wonderful, but weight lifting resistance exercises are best for bones and heart. And you will feel much better if you do the weight lifting.
When women agree to taking hormones, most doctors prescribe synthetic hormones such as Premarin (an extract of horse urine) and a synthetic "progestin," a manufactured unnatural progesterone alternative. There are natural forms of estrogen, and (micronized) progesterone, all of which can be applied in their most effective form as patches or lotions. (The latter has been documented to reduce one of the key elements of hardening of the arteries--NEJM 1966:335:453). Using a patch reduces the destructive first-pass metabolism of these medicines in the liver, which occurs when you take a pill by mouth as 100% of the blood flow from the digestion of these pills passes through the liver on this very "first pass." By using this medicine as a skin patch or lotion, you avoid "first pass metabolism."
The natural forms of estrogen are estrone (E1), estradiol (E2), and estriol (E3). These can be joined as "Biest" (preferred) or "Tri-Est" which is 10% E1, 10% E2, and 80% E3, and E3 may even reduce the incidence of cancer of the breast. But even E3 (estriol) raises the frequency of cancer of the uterus when compared to non-users. There is no study that states that estriol (E3) causes less, the same or more cancer than other estrogens - but, to me. it is still "more natural." These natural forms of estrogen joined with micronized progesterone may be the safest of the hormone replacement therapies in my best judgement.
It is all entirely your choice and you may discuss this information with your gynecologist and/or HMO. For further information and availability you may contact Market Square Pharmacy in Newington (666-3391). Prescription Specialties in Cheshire, (203-250-0445) or Women's International Pharmacy (800-279-5708).
H. Robert Silverstein, MD