Confusing Research on Hormone Replacement Therapy

The findings of numerous studies on hormone replacement therapy (HRT) conflict and, as a result, have raised serious questions regarding the appropriateness of HRT. Does HRT improve women's health by decreasing the risk of heart disease, stroke, osteoporosis, and Alzheimer's disease? Reputable sources provide conflicting answers.

Here’s what we know. With one exception, the major studies either fail to distinguish among types and dosages of HRT used in the study, or examine only synthetic HRT preparations. This occurs primarily because studies are usually funded by pharmaceutical manufacturers, who profit by selling patented synthetic hormones. Bio-identical hormones, which are chemically identical to hormones produced naturally in the human body, are not patentable. Most bio-identical preparations are customized for the individual patient by a compounding pharmacy.

Studies have demonstrated that in monkeys who have had their ovaries removed, treatment with bio-identical estrogen reduced arterial plaque formation by 50%. Primate studies have also illustrated that the synthetic hormone medroxyprogesterone acetate (MPA) negates the benefits of estrogen therapy. MPA has been shown in primate studies to constrict coronary arteries, causing vasospasm and heart attack, while natural progesterone beneficially dilates coronary arteries.

The American Heart Association (AHA) has proposed that HRT should not be prescribed to women for the sole purpose of preventing recurring heart attacks or strokes. The recommendation was based in part on results of the Heart and Estrogen Replacement Study (HERS), because the estrogen/progestin combination used in that trial failed to prevent further heart attacks in women who already had heart disease. Unfortunately, HERS relied solely on the use of one synthetic estrogen and progestin combination. Numerous studies are in progress which are investigating the role of bio-identical hormones in preventing cardiovascular disease.

We agree that a decision about HRT is best made taking a broad, long term view of a woman's health goals, symptoms, and lifestyle.  Prevention of a first heart attack or stroke should begin with reducing risk factors such as high cholesterol and blood pressure, while considering issues of smoking cessation, weight management, and exercise. However, we believe that antihypertensives or cholesterol-lowering medications should not be used as an interchangeable alternative to HRT, particularly for women seeking long-term heart and bone protection, increased energy, restored libido, and renewed mental clarity.

It is regrettable that various guidelines address hormone replacement in general terms, with all forms of "HRT" lumped together as if they were a single medication. In reality, women's experiences and clinical outcomes of HRT differ vastly depending on the dose, dosage form, and route of administration, and most importantly, whether the hormones are synthetic or bio-identical.

 
Copyright 2004, Storey Marketing - Monthly Website Updates. Reproduction prohibited. Subscription available through Storey Marketing (814-337-3441). Questions regarding this article should be directed to the compounding professionals at Thrifty Health and Compounding Pharmacy.