Is there a HRT dilemma or let's use common sense....

The Prempro study:

May of you have read the recent newspaper reports regarding the use of Prempro, an estrogen-progestin synthetic combination. The report from the Women's Health Initiative (WHI) follows overwhelmingly conclusive evidence that the risks involved in taking Prempro seriously outweigh the benefits. Side effects noted in the study included the elevation of breast cancers (26%), heart attacks (29%), blood clots (100%) and heart disease (22%). The real "dilemma" is not these findings....read on please.

The WHI is an organization established by the National Institutes of Health (NIH), in 1991, to address the most common causes of death, disability and impaired quality of life in postmenopausal women. Their evidenced based discontinuation of this study fully contradicts prior beliefs, by some, regarding the estrogen-progestin usefulness for reducing bone loss, and heart benefit, along with its

Menopause:

Perhaps a quick discussion regarding natural selection is in order? Consider this prospective; nature has a grand scheme that is based roughly on the concept that to maintain and evolve as a species three basic groups of individuals are needed. There are those in the juvenile, adults and elderly age brackets. For the purpose of this commentary, consider that once a woman has reached a non child-bearing age, i.e. menopause, she is no longer a viable member to continue the species, reproductively speaking. Please keep in mind this is a simplistic overview and in no way is intended to discount the value of older women.

When we manipulate the hormonal levels in your body we are very much changing natural selection. Having trained in anti-aging medicine and achieving board recognition, I feel it's very much appropriate, desirable and a necessary step toward maintaining a healthy mind, body and spirit. I very much support working within a generally natural approach to modifying the grand scheme.

Lets explore the quality of life issue that should be paramount, from my prospective. Remember that the female body is dependent on certain levels of hormones to maintain the integrity of the skin, certain mental functions, lubrication of the vagina, breast integrity and weight concerns. Why should any woman experience a decline which would result in hot flashes, mood lability, urinary and vaginal infections, decreased libido and the list goes on...

While we consider HRT as Estrogens and Progesterone keep a prospective regarding the many other essential hormones that play an equally important part in maintaining our health. Testosterone along with the adrenal hormones, cortisol and DHEA coupled with thyroid change as we age. These major players are equally important when considering the overall picture.

Now for some definitions.

There are THREE types of estrogen. E1, E2 and E3 are the abbreviations for Estradiol, Estrone and Estriol. These three are substantially different in their level of stimulation of tissues.

Estradiol is 80 times stronger than Estriol and 12 times more stimulatory than Estrone. To appreciate the difference consider the hormones as keys that open a lock and hence a door that allow the cell to get a message to produce a protein or other function. If the lock is occupied by a "weak" estrogen including plant based estrogens, the result is a mild response. If estradiol or estrone occupies the lock a strong signal is generated and the cells respond with a significant response.

As a menstruating female the primary estrogens consist of estradiol as the majority member, with that changing following menopause, to Estrone.

Levels and time of estrogen exposures, over a woman's lifetime, has been the primary factor leading to increased cancers. Two years ago the combination theory of using progestins and estrogen was shown to increase your risk of breast cancer in the Journal of the American Medical Associations publication JAMA January 26th issue.

Prempro is not solely a combination of these three estrogens and progestin. The conjugated estrogens present in this product consists of a large group of horse estrogens that are not identical to human estrogens and have shown specific damaging effects to our DNA, hence some of the cancer causing issues. Its curious how much information was published in 1998/99 and now it's become NEW….One needs to question the deception of the consumer. For an in depth look at some of the old studies click on the publication.

1. Evidence that a metabolite of equine estrogens, 4-hydroxyequilenin, induces cellular transformation in vitro

2.Equine estrogen metabolite 4-hydroxyequilenin induces DNA damage

3. Damage by equine estrogens

If you're wondering how Wyeth Pharmaceuticals "harvests" this product, from horses, specifically horse mare urine, click here.

Progesterone

In the current marketplace there are two formats for progesterone. Progesterone is the naturally occurring form, whereas progestins are a group of exclusively synthetic mimics. The progestins have a very different set of effects and were created for the benefit of pharmaceutical firms seeking a patentable unique molecule. Not unlike many other man-made images of natural products, the differences are rather significant. As an example, unlike progestins, natural progesterone has been shown to be neuroprotective (protects the spinal cord) Journal of Neurotrauma 2002 March 19(3):343-55. Whereas progestins decrease the beneficial effects of decreased insulin resistance, when coupled with estrogen.

Pharmacy considerations:

For the last 30 plus years the Europeans have been marketing many combinations of the natural estrogens and progesterone, as mainstream prescriptions. During their extensive use Estriol, the weak estrogen, has shown some protection against female cancers. The two examples that follow although rather medical and not lay publications should give you some idea. At the PubMed you can research via key words and find a wealth of information. Check out these two references: Estradiol vs Estriol. or perhaps Regulatory effects on T cells.

By using a compounding pharmacy approach we at the Center of Health have for twenty years given women and men a Customized personal and unique method of meeting their medical needs. This cannot be done with the classic conventional limited number of prescriptive strengths available, like Prempro. Prempro is available in only two formats .625/5mg and.625/2.5 mg. If you need a dosage somewhere between these you prescriptions your choice is to either take the less potent prescription and retain some of the symptoms or take the next higher dose and tolerate the side effects. Neither seems appropriate nor desirable, from my prospective.

There are differences between compounding pharmacies. With the recent court case maintaining the legal right of pharmacies to produce unique products the public can and has an ability to have their physician customize the potency delivery system,(topical, oral, suppository, sublingual, etc.) and combinations. At the Center of Health we found over the years that for consistency and pricing the larger established members of the compounding pharmacies provide excellent service, value and quality control. Not unlike most other industries, the larger pharmacies are able to purchase in larger quantity providing for better pricing, pioneer some of the most exciting breakthroughs years ahead of others and consistently deliver the product in a day or so.

Potpourri of Products:

The marketplace is flooded with generic and brand name HRT products, including a vast array of herbal and prescription combinations. Many women have noted benefit with these products and there is a need for these and other approaches.

Some of the herbal products have had a number of double blind well done studies to address their effects. However, the distinction is significant as the studies are based on symptom relief and NOT cardiovascular protection or bone formation. This is due to the fact that although the plant based estrogens and progesterones are capable of binding to the same receptor sites, similar to the real estrogens and progesterone, they do not increase the actual hormone levels.

I will endeavor to add a section to this area of consideration as well as external estrogens from herbicides, pesticides and plastics. As a starting place to explore this very important aspect of hormones and their effects you might want to venture into some hard science by reading Organochlorine pesticides and chlorinated hydrocarbon solvents in the blood of chemically sensitive patients. A statistical comparison with therapeutic medication and natural hormones.
More info shortly...

What to do ??

So what's a woman in menopause to do ?

First: Don't panic or abruptly stop your medication.

Second: Step back and assess your own and family health history.

Third: Consider your response over the years to the various approaches you've used for treatment of symptoms, if any were present.

Fourth: Employ a more comprehensive, individualized whole-body method of addressing your needs. At the Center of Health™ we spend the time necessary to develop a plan of action that will enhance your health and weigh the factors of your lifestyle, risks and desires.

Together, an overall health approach that meets your needs is available. Call our office for an appointment and stop putting your health at risk.

More questions? ask Dr. Kadish, at the Center via e-mail at drk@centerofhealth.com, or contact us at 541.773.3191