Hormone Replacement Therapy in Menopause:  resolving the controversy

Hormone replacement therapy for post-menopausal women began as a panacea and has subsequently become a controversial topic:  is it safe? Is it foolhardy? Does it make any difference what kind of hormones a woman takes?  Finally some clarity has appeared!  Dr. Kent Holtorf, in the January 2009 issue of Postgraduate Medicine, has presented a thorough analysis based on his review of the existing literature.   As it turns out…

Not all kinds of hormones are the same!  

The hormones that are identical to those made by a younger woman’s body turn out to be not only safer than synthetic or horse-based hormones, but perhaps safer than no hormones at all.  Biodentical hormones include estradiol and estriol and progesterone.  Synthetic hormones include CEE (horse based estrogen) and progestins.

What about hormones and breast cancer?

Well…as it turns out, progesterone, bioidentical progesterone, reduces the risk of breast cancer arising as a result of menopause or as a result of postmenopausal estrogen therapy.  Progestins increase the risk of breast cancer. In addition to the safety considerations, women personally prefer progesterone to the synthetic progestins, noting less physical and emotional side effects. 

Estrogen comes in three forms in the human body:  estrone (prevalent in menopause), estradiol and estriol.  In appropriate combinations, they can either promote or inhibit breast cancer development.  Estriol appears to be the most anti-cancer form of natural estrogen.  Synthetic, or horse based estrogen, increases breast cancer risks. 

What about heart disease?  

Hormones have also been implicated as a cause of heart disease.  Once again synthetic progestins are found to be hazardous, while progesterone appears protective.    Estrogens and heart disease have a more complicated relationship.  Synthetic estrogens have a mixed effect – in some ways beneficial, in other ways harmful, while bioidentical estrogens reduce the risks of heart disease and stroke. 

Early hormone therapy raised the rate of cancer in the uterus.  ONLY in the uterus does there appear to be no significant difference between synthetic and bioidentical hormones:  All forms of estrogen raise the risk and either progesterone OR progestin lowers it

There is no longer any justification for the use of synthetic estrogens or progesterones in post-menopausal women. Bioidentical hormone therapy offers the possibility to reduce some of the disease risks often associated with menopause.