Are You Still Afraid of Taking Hormones for Menopause?

Ever since the Women's Health Initiative (WHI) study in 2002 claimed that hormone replacement therapy (HRT) increases the risk of breast cancer many menopausal and postmenopausal women have been living in fear, depriving themselves of all hormones, and suffering from an estrogen and progesterone deficiency. The passing years revealed that the WHI results were grossly misrepresented and irresponsibly exaggerated, but in spite of this, in October 2010, the WHI published another analysis in the Journal of the American Medical Association (JAMA) which reported that HRT not only increases the risk of breast cancer, but also increases the risk of death from breast cancer. (1) Whichever stand you take regarding the results of the WHI, one thing is for sure, the WHI only studied the effects of the hormones Premarin and Provera (in a combined form called Prempro) on postmenopausal women with an intact uterus.

Premarin (a mixture of horse estrogens) and Provera (the synthetic progestin medroxyprogesterone) are foreign and synthetic hormones which are different in molecular structure from estradiol and progesterone that are naturally found in the human body. That means they don't properly fit in human hormone receptors, aren't metabolized well by the human body, and in turn don't work optimally and cause problems. Bioidentical estradiol and progesterone are identical in structure to estradiol and progesterone which are naturally produced by woman's ovaries, and are used in bioidentical hormone replacement therapy (BHRT). BHRT has better efficacy and is not associated with the same risks as conventional hormone replacement therapy (HRT).(2)

Again, Premarin and Provera are hormones which are not naturally found in the human body. Furthermore, they are administered together (Prempro) in the same dose every day... which is not physiological. That is, it is never natural or normal for a reproductive woman to have the same levels of hormones in her body each and every day.

Specifically, the Provera component of Prempro is a synthetic progestin taken every day, which is supposed to mimic the actions of natural progesterone. However progesterone is naturally released in a reproductive woman only after ovulation and only for 2 weeks of her cycle (unless she becomes pregnant), not every day.

The culprit causing the increased risk of breast cancer when using Prempro is probably the Provera since other studies using only Premarin have not shown an increase in breast cancer. Nevertheless, it is important to recognize that the effects of hormone therapy likely depend not only on the molecular structure of the hormones being administered, but also on whether the hormones are taken in a manner which mimics a reproductive cycle.

In my practice I use BHRT2 to treat peri-menopause, menopause and postmenopause, in a way which best replicates a reproductive woman's hormone cycles.

Copyright Shira Miller, M.D. Inc.

1 Reference
2 Reference