What if we had a new medication that slashed the risk of the leading cause of death by about 50 percent? And what if that medication also helped prevent osteoporosis and dementia?
That same medication is not a medication at all but rather one of our own hormones normally found in our body up until middle age. It's called estrogen, and a recent study reiterated what we've actually known for over a decade - estrogen replacement after menopause prevents disease and improves quality of life!
The October edition of the British Medical Journal published the Danish Osteoporosis Prevention Study by Dr. Louise Shierbeck and colleagues, which followed 1,000 women for 16 years after menopause. The treatment group replaced their falling hormones with estrogen and a progesterone-type drug called norethindrone. The results revealed a whopping 50% reduction in heart attack in the group that replaced their hormones, with no increase in breast cancer. That's right, no increase in breast cancer risk.
The critical issue here is the age in which women start Hormone Replacement Therapy (HRT). The earlier the better, and if HRT is started within 5-10 years after menopause then the risk of heart disease goes down. Many studies have found neutral to increased risk of heart disease when HRT is started more than 10 years after menopause.
For many of us practitioners specializing in HRT, this study confirms what was already well known from prior studies showing similar results, such as the Women's Health Initiative and the Nurses' Health Study, both of which showed a reduction in the risk of heart disease in women taking HRT when it was started within 10 years after menopause.
It seems estrogen has a beneficial effect in preventing plaque in arteries as long as estrogen levels are maintained. If women go through menopause, develop artery plaque, and then start HRT years later, the estrogen can actually cause the plaque to rupture, thus increasing the risk of heart disease.
So can older women start HRT? Yes, but prior to starting women on HRT who have not taken it for more than 10 years we go through a process to examine their artery health and stabilize any artery plaque we find.
After the results of the infamous Women's Health Initiative were released in 2002 which showed that a progesterone-type drug called Provera caused increased breast cancer risk, hysteria ensued with doctors telling women to "stop your HRT right away." This advice was indeed appropriate for Provera, but not for other forms of HRT. It would be like recalling all automobiles because one particular model is defective. The evidence was not there nor is it there to make such a blanket condemnation of HRT in general.
Another landmark study was just resulted this week showing the favorable benefits of HRT. The KEEPS (Kronos Early Estrogen Prevention Study) found that HRT with low-dose oral or transdermal estrogen and cyclic monthly progesterone started soon after the onset of menopause improves depression, anxiety, and cognitive function in healthy women and does so without promoting or worsening cardiovascular disease.
"KEEPS provides evidence that combined hormone therapy in recently menopausal women shows no evidence for cardiovascular harm in terms of either imaging of the arteries or known biomarkers or risk factors for cardiovascular disease," co-investigator Dr. S Mitchell Harman said in an interview.
The current conventional medical recommendations on HRT are not to take them, and if necessary, take them only to control symptoms such as hot flashes and mood swings, and then only take them for a short time. This advice is based on the WHI data, which showed increased breast cancer risk caused by the drug Provera. In the case of Provera I agree - don't take it. My advice goes further - don't ever take it for any reason.
However, the current HRT policy misses the mark on several levels. First of all, condemning all forms of HRT based on the negative effects of Provera is simply shortsighted. There is plenty of evidence that bioidentical hormones, in particular progesterone, do not share the side effects of Provera. In fact, multiple studies show progesterone actually reduces the risk of breast cancer.
Second, withdrawal symptoms such as hot flashes and night sweats are not the compelling reason to take HRT. The reason to consider HRT is to prevent disease and maintain or improve quality of life! I suspect these recent studies showing HRT is good for the heart will lead to a change, albeit slowly, to the current recommendations.
It breaks my heart to hear so many stories from women suffering with hormone imbalances or deficiencies while being told "there is nothing they can do" or "it's just part of getting older." I say, "Bull!"
The first year or two after menopause many women begin to show signs and symptoms of low hormones, including weight gain, especially around the middle, poor sleep, depressed mood and low sex drive, loss of skin radiance, loss of hair except for some annoying new facial hairs, and just feeling "old." The athletes note a decline in energy and stamina. Most of these women are in their early to mid-50s and just hitting their prime!
So what happens to women at menopause? Do they suffer from an acute deficiency of Prozac? Are they anxious and not sleeping due to a low Xanax level? Of course not. But doctors prescribe anti-depressants, sleeping pills, and incontinence pills, tell them to use lubrication for sex, and just eat better and exercise more and they'll lose weight. Preposterous!
Letting our system run out of hormones is much like letting our car run out of oil and expecting it to keep running fine. Don't wait for the red light to come on before taking action - HRT is an updated science and will eliminate or reduce the symptoms of hormone decline.
Humans are genetically programmed to reproduce and to survive. By the end of our reproductive years we start a steady decline in hormone levels that will lead directly to increased risk of degenerative diseases and a lower quality of life. Due to modern medicine, nutrition, and sanitation we've already "fooled" Mother Nature and extended the average life span to about age 80. If we are going to live to 80 then we darn sure need to do everything we can to prevent disease and have a high quality of life.
Adding years to your life is perhaps not as important as adding life to your years. HRT is one important element to consider in the quest for healthy aging.
Scott Rollins, M.D., is board certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com)and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call 970-245-6911 for appointments or more information.