QUESTION OF HORMONE REPLACEMENT THERAPY:
WOMEN ARE SCARED OF CONVENTIONAL HRT:
Today most women are scared to take conventional Hormone Replacement Therapy (HRT). There are many reasons behind such fear; however, breast cancer and failure of response to HRT are the crucial worries for the patients.
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HRT was given to women to reduce menopausal symptoms and atherosclerotic processes in blood vessels. Atherosclerosis is clogging of the arteries due to deposition of fatty plaque. Estrogens were thought to provide some kind of protection from plaque formation and therefore protection from heart attack and stroke. To the disappointment of physicians and patients, many studies have revealed that HRT fails to provide such protection. One of the largest studies carried out in the UK concluded that women who took conventional HRT including Premarin and Provera or PremPro had significantly higher risk of developing breast cancer. They also had a higher chance of dying of their disease. The study was published in the renowned scientific journal ‘Lancet’ in August, 2003.
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Another study concluded that women who took HRT for five years had a 29% higher risk of breast cancer, 26% higher risk of heart disease and 41% higher risk of stroke. This was another blow to the HRT advocates.
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Many women who were on HRT continued to experience the distressing effects of menopause such as hot flashes, night sweats, sleeplessness, mood changes, weight gain, changes in hair, skin and libido along with vaginal dryness, etc.
The Women’s Health Initiative (WHI) study was cancelled because of such risks of HRT.
SO WHAT SHOULD BE DONE?
Many women do need HRT to cope with their menopausal symptoms. However, a standard hormonal therapy is not justified for every woman. In our clinic we follow a systematic approach which consists of:
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estimation of female hormonal panel.
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making a hormonal replacement therapy plan according to the results of that patient’s hormonal panel.
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clearing the xenoestrogens (environmental estrogens) .
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preparing and balancing the body to enhance the bioavailability and assimilation of the replaced hormones. We will discuss these steps briefly here:
A) Estimation of Hormonal Panel
Hormonal assessment can be done from blood, urine or saliva. Saliva testing is superior and particularly useful because it measures the active, free, non-protein bound fraction of hormones. It is the unbound, free fraction of the hormone which exerts its actions in the body. The saliva test also measures different components of estrogens, which is important because all types of estrogens are not equally carcinogenic. Hormonal ratios are calculated to facilitate which hormones need to be substituted. It is also an easy, convenient and non-invasive way of testing the hormone levels.
Saliva testing has another edge over blood and urine tests. If a woman is already on HRT, the saliva will clear these external hormones within a few days of stopping the HRT. Blood and urine may take more than two weeks to clear the external hormones.
We use both saliva and blood samples for initial hormonal assessment along with a full panel of thyroid hormones.
B) Hormonal Replacement Plan:
Once your reports are back, we will discuss your results with you. These results will help us decide your replacement plan. Natural and bio-identical hormones are prescribed. These are prepared from a plant extract or compounded at a pharmacy and are identical to the ones made in our body. The synthetic hormones are prepared either in the lab or from horse’s urine. (‘Premarine’ means: the Progesterone from the urine of a mare) Being different and synthetic, they are associated with cancer and other side effects. The dose prescribed for you will be just enough to bring you to the physiological levels of hormones. You may also require thyroid replacement therapy depending upon your results.
C) Clearing Xenoestrogens and Estrogen Dominance:
There are multiple approaches to this problem: some of the modalities we use are antioxidants, infra-red sauna, oral supplementation and chelation therapy.
D) Balancing and Preparing the Body:
A balanced and well prepared body promotes healing through its own healthy resources. This is done through dietary, nutritional, and lifestyle changes along with therapies such as acupuncture, natural supplements and herbs. The natural remedies we use have been widely used and found to be effective. Some of the natural supplements are flax seed, black cohosh, indole-3 carbinol, glucaric acid, essential fatty acids and CoQ10.
Throughout your treatment plan you will be followed by a licensed physician. On every visit you will have ample time to ask questions to understand your therapies to your full satisfaction.
