Menopause is not a disease. It is a normal phase of life that marks the end of the menstrual cycle. However, during early adulthood, women are protected by several hormones including estrogen and progesterone. These hormones help women maintain good heart health and help women maintain their bones. They also help women think clearly. When these hormones are lost at menopause, women become more vulnerable to heart diseases, osteoporosis with hip fractures and Alzheimer’s disease. These happen to be the three leading causes of death in older women.
Since the famous Women’s Health Initiative (WHI) study, which was initially published in 2002, the use of hormones declined dramatically. That’s because the study authors and the media exaggerated the study’s negative findings and underemphasized the study’s many positive findings. As a result, a mass panic developed about hormone replacement such that most physicians stopped prescribing it and most women wanted nothing to do with it.
Unfortunately, when they stop using hormones, which is the most effective way to prevent the three greatest causes of women’s death, women are more vulnerable to these three diseases. There have been several medical journals in the last two years that have published articles highlighting the decreased life expectancy for women as a result of not protecting themselves with hormone replacement.
The most common response I hear when I speak to women about hormone replacement is that they are afraid of breast cancer. However, this is pure myth. Estrogen does not cause breast cancer. In fact, the compendium of studies reveal that estradiol actually mildly reduces the incidence of breast cancer. The one hormone that was associated with breast cancer was Provera, which is a synthetic version of progesterone. The natural or bioidentical version actually protects against cancer as progesterone is anti-proliferative. This means that progesterone reduces the progression of cancers. The ironic thing is that as the subjects continued to be followed over the ensuing five years, even Provera’s cancer association weakened, but this did not make for good headlines so even most doctors are not aware of this result. The bottom line is that estrogen does not cause cancer and, if anything, provides some protection against breast cancer. Bioidentical progesterone further protects against cancer.
The other error that many doctors make is the misconception that hormone replacement causes strokes and heart attacks. This is because in the WHI study, some of the older women started on hormone replacement had an increased risk for cardiac events during the first year they took hormones. As noted above, estrogen protects against heart disease and younger women had cardiac benefit in the WHI study. The presumed basis for these events is that estrogen causes clots to be dislodged. The older women in the study were more likely to have clots and once the clot is dislodged, strokes and heart attacks can result. Interestingly, these events tend to occur in the first year. After that, even older women received cardiac benefit from estrogen.
Another source of the cardiac error is that in the WHI study, Premarin was used. Premarin is a truncated word for pregnant mares’ urine. Animal rights issues aside, the biggest concern about Premarin is that it is a stronger estrogen than estradiol, which is the bioidentical version of what humans naturally produce. As a stronger estrogen, Premarin has a tendency to dislodge clots but no study has ever shown that estradiol has such a tendency. Thus, bioidentical estradiol is not associated with heart attacks or strokes. To the contrary, the relative risk of heart disease for women who take estradiol is 0.4 compared to women who do not take estradiol. That means that if a woman does not take estradiol, she is 2.5 times more likely to get heart disease.
The most costly error is that medical societies and organizations have generally recommended hormone replacement for women only when they are having menopausal symptoms such as hot flashes and to take them for the shortest possible time at the lowest dose that reduces symptoms. However, we have learned that women who have hot flashes are at higher risk of the diseases associated with menopause, including heart disease, osteoporosis and Alzheimer’s. One study found that women with hot flashes had increased white matter loss on brain MRIs. Even insulin resistance, which is associated with diabetes mellitus, is increased in women with hot flashes. By taking hormone replacement, women significantly reduce the risk of these diseases. The misconception that women should minimize hormone use has deprived them of a key tool to reduce the risk of such deadly diseases.
Women have been led to believe that hormone replacement is very dangerous. Many women do not even consider hormone replacement because of this; I often see a visceral reaction against hormones that is based on misleading information. I am optimistic to see the medical community starting to realize the harm caused by discouraging hormone use.
Menopause is a challenging time for many women. It is often accompanied by weight gain of 10-20 pounds, increased fatigue, insomnia, depression, decreased libido and even increased joint and muscle pain. I hope that women are encouraged that with bioidentical hormones, women can reverse all these symptoms with weight loss, improved energy, improved mood, improved sleep and improved libido. At the same time, women can reduce the risk of the three leading causes of death for older women, including heart disease, osteoporosis with deadly hip fractures and Alzheimer’s disease. So by starting bioidentical hormone replacement, you reduce your risk of disease and improve your quality of life.
Dr. Slaten is a wellness physician specializing in regenerative pain treatments and lifestyle counseling. He is certified in advanced bioidentical hormone replacement.
