|
Note to reader: We report HRT and Women's
health news as it comes out, this section is arranged with
the most recent news on top.
BIOIDENTICAL HORMONES
Women often ask me what I think of these and I do like them better than conventional
hormones, but only if all else fails. Keep in mind that it has
been estimated that 85% of women can find relief during this transition we
know as peri menopause/menopause by using one or a combination of lifestyle,
nutiritonal and/or herbal supplementation.
As a refresher, we produce three different
strengths of estrogen. From strongest to weakest they
are estradiol, estrone and estriol. Estradiol is most
prevalent in reproductive years as it plays a major role
in follical (or egg) development, estrone is more prevalent
in menopausal years and estriol is prevalent throughout your
life but most dominant during pregnancy. (see http://www.oonahealth.com/peri.html for
a full explanation and click on "estrogen")
The definition of bio-identical hormones
is what the name implies -they are made from plant sources
and modified to identically match the chemical structure
of hormones made naturally by our bodies. Synthetic
hormones, while we often think of Premarin and horse's urine,
may also come from plant sources. The difference is
that these are not processed to match human hormones and
tend to be much stronger.
There is another important difference -
as there are conventional (pharmaceutical) hormones that
are bio-identical. Conventional therapy either supplies
just one of the two strongest hormones - estradiol or estrone
- or, more recently, a set combination of the two. Bio-identical
treatment includes all three estrogens and is made specifically
for you based on a blood or saliva test. Prescribed
by a healthcare professional, bio-identical are then made
up at a Compounding Pharmacy. (Compounding pharmacies are
not regular pharmacies)
Compared to conventional hormones, it is
believed and shown that bio- identical hormones are metabolized
closer if not the same as our own hormones and therefore
produce the same effects with less adverse effects. And
while there are European studies that show they are indeed
safer, there are no long term studies that prove it either
way. It is assumed that bio-identical and conventional
pose the same risks - risks such as breast cancer and blood
clots.
One of the main criticisms of bio-identical
hormones is that they are unregulated and therefore somehow
dangerous as it is generally believed that they are safer. If
they are compounded in a reputable pharmacy, of which there
are many, this criticism in my opinion is unfounded. It
must be taken into consideration that only conventional or
synthetic hormones can be patented - these companies have
a lot invested in making us believe that only their products
are safe.
However, there are questions that don't
seem to have clear answers. The procedure for this
regime is to get a saliva or blood test that tests your hormone
levels. There are differing opinions about which test
is more accurate, which leads me to believe that neither
is reliably accurate. Some say saliva testing is better
because it tells how much estrogen is available to be absorbed. Apparently,
blood tests can't tell you that. Others say blood tests
are better because saliva tests can differ so greatly at
different times of the month or even day. Then there
is the question about what level you should be obtaining? If
you don't have a baseline from your late 30's early 40's,
it would seem to me, very difficult to determine. The
going consensus is to just add the least amount of hormones
to obtain relief. If three estrogens are being compounded,
it seems like a difficult balance to obtain without a baseline. However,
if you compare this procedure to conventional treatment that
personalizes very little if at all, this does seem better.
Oöna works very well for me - however, if nothing worked
and I was miserable, I would try bio-identical for a shortest
period of time. I think that Dr. Susan Love makes an
important point - it is not safe for us to maintain reproductive
amounts of hormones for our whole lives. This is why
we go through menopause. Respecting nature and tampering
with this biological process A LITTLE seems okay - but how
much is too much and how long is too long? It's becoming
more and more apparent that the answer is an individual answer. At
least, in my opinion, bio-identical hormones are a step in
the right direction.
So how do you find a health care professional
that will work with you on this? Besides asking around,
I would work backwards. You can call a Compounding
Pharmacy in your area or find one by contacting The International
Academy of Compounding Pharmacists at 800-927-4227. Ask
for a reference to an MD or other healthcare professional
that uses their services.
My favorite on the subject - the first
one is selling a program of some nature but offers a great
explanation.
http://www.womenshealth.com/patientinfo/NHRT.pdf
http://www.drnorthrup.com/menopause-2.php
http://susanlovemd.com/community/questions/question020812.htm
Mostly con-bioidentical.
http://www.minniepauz.com/bio-identical-hormones.html
http://news.yahoo.com/s/nm/20051031/hl_nm/hormonetherapy_dc
http://www.healthywomen.org/Documents/BioidenticalHormones.pdf
Newsletter
November/December 2005
THE PATCH
Considering hormonal birth control has been around for more
than 30 years, why is any increased death rate acceptable? That's pretty much what "Experts" are
saying about the recent deaths from the hormone patch. In November of 2002
- Time Magazine chose the hormone patch as one of the "coolest inventions". Because
of once a week dosing, it quickly became a popular form of birth control. See
2002 Johnson & Johnson press release (J&J owns Ortho-McNeil, maker
of the patch) http://www.jnj.com/news/jnj_news/20021111_094741.htm.
In 2004, it is estimated that 800,000 women
used the patch. Last month, AP broke the story
that there have been 23 deaths related to the patch, 3 times
as many as expected from birth control pills. 17 of these
deaths are related to blood clots - the most serious concern
with hormone birth control. Blood clots generally start
in the legs and can be dangerous if they move to the heart,
lungs or brain.
As the AP article points out, blood clots
are an acceptable side effect of birth control pills - it
is known that higher amounts of estrogen promotes blood coagulation
or thickens the blood. But how much is acceptable? (Side
note: how could they ever have thought that HRT would be
beneficial for heart health in menopausal women if this is
a known effect of estrogen in the blood? True, it's
arguable that women of transition age are estrogen deficient,
but unless every woman is prescribed the exact amount needed
individually (highly improbably), is it not obvious that
estrogen and heart health would not go together? Am
I missing something?)
The main points in the AP piece are as
follows:
- The AP found that before the patch was
approved, the FDA was aware that nonfatal blood clots from
the patch were three times that of the pill. The AP then
found that since the patch has come out, deaths also appear
to be at least three times as high.
- A woman on the pill who does not smoke
and is under 35 has between a 1 and 3 in 10,000 risk of
having a non fatal blood clot. Risk of dying from
a blood clot is 1 in 200,000.
- For the patch it's 12 in 10,000 for a
non-fatal clot and death rates appear to be 3 in 200,000.
- In 2000, doctors at the FDA reviewing
clinical trials of the wafer-thin, plastic patch warned
that blood clots could be a problem if it was approved.
- Even with the FDA warning, the patch was
approved with no requirements for follow-up beyond routine
FDA reviews of reports called in by consumers, doctors
and manufacturers.
Why the difference? It is believed
that it could be the ways hormones are absorbed - even though
the amount of hormones is similar for either prescription. In
the pill they are conjugated through the liver - taken by
the patch, they are directly absorbed into the skin.
Those defending the patch claim that these
risks are in line with what they expected and that no further
investigation is needed as they are very low. They
also claim that pregnancy has a much higher death rate than
the patch - so don't get off it. (sorry, that one's lame
- it implies the patch is the only option to prevent pregnancy)
They also state that more information will be known as more
and more women use the patch - for now, there is no reason
for concern. (how comforting) And finally the MD's associated
with Ortho claim that it is safer than the pill. (that one
you got to read for yourself, it sounded like double talk
to me) None of this defense is convincing to me (ya
think?) but I've provided links for you to read for yourself
- In all seriousness, I'm particularly upset by the fact
that no follow up studies were required -- AGAINST what the
FDA's own researcher advised. If you get along with
the pill, (I never did) it's clear that it is safe - why
not stick with tried and true?
One other note: In an article published
in the North American Menopause Society (NAMS) magazine last
month (heavily pharmaceutically sponsored) the authors basically
slammed HRT "bio-identical hormones" that women
can get in a compounding pharmacy - their main point was
that these hormones are delivered in mostly gels and lotions
absorbed by the skin and we don't have enough information
about how these are absorbed and used by the body. Just
pointing out the contradiction and how this point is being
argued both ways - one way to defend a drug and another way
to discredit an alternative.
http://wusatv9.com/health/health_article.aspx?storyid=41226
http://msnbc.msn.com/id/8565177/rebuttal
http://www.medicinenet.com/script/main/art.asp?articlekey=52626
WE KNEW THIS
from experience but now it looks like an initial study published
in JAMA has confirmed our experience as women. The truth
is that very little is known about women who stop hormone
therapy. The theory has been to take HRT through the difficult
years - get through that time period and then stop HRT
when it should all be over. The idea was to "skip
over" the symptomatic period by taking hormones and
come out the other end symptom free. Well, it turns out
that most women's experience has been that HRT just postpones
the symptoms, it doesn't skip over them.
This study looked at a cross-section of
8405 women that were advised to stop the estrogen plus progestin
as a result of the WHI study. They mailed them a survey
8-12 months after the stop date. More than half the
women with vasomotor symptoms at baseline reported symptoms
after the therapy was discontinued - and this was at an older
age of 69.1 after taking the therapy for 5 years. Further
investigation needs to be done as this study did not include
women who stopped taking it earlier or were unwilling to
be randomized. However, it does accentuate the point
that women should take HRT for the shortest duration possible
and the alternative methods to manage symptoms need to be
considered.
http://jama.ama-assn.org/cgi/content/abstract/294/2/183?lookupType=volpage&vol=294&fp=183&view
http://www.4women.gov/news/english/526792.htm
Newsletter August
2005
CONTRAVERSY CONTINUES
You won't see this on the nightly news, but the World Health
Organization (WHO), part of the UN, has added HRT to it's
list of carcinogens, updated from "potential carcinogens". This
comes after several recent high-profile studies linking
combination hormone replacement therapy, or HRT, to breast
cancer. The Organization puts the breast cancer risk for
those on HRT to 1 in 6, vs. 1 in 7 who don't use the drug.
The cancer research agency also concluded that a common
type of birth control pill, taken by about 10 percent of
women of reproductive age, increases the risk of more types
of cancer than previously thought. The scientists acknowledge
that it's a complicated picture and there are benefits
to HRT. (see link below)
At the same time an interesting report
out of The Harvard School of Public Health and published
in the Journal of Epidemiology and Community Health this
month that centers around the question "Why did concerns
about HRT get overlooked, when are awareness of these concerns
dates back to the 1930's?" According to the Dr.
Koop website,
"The authors
pinned their paper around this question: "Why, for four
decades, since the mid-1960s, were millions of women prescribed
powerful pharmacological agents already shown, three decades
earlier, to be carcinogenic?"
The complicated
answer, as the authors see it, includes an industry that
is not tightly regulated; the ascendancy of individual as
opposed to collective risk; and the "gendering" of
hormones involving longstanding beliefs that sex hormones
explain women's and men's behavior and biology.
Socially
responsible research, they conclude, needs to include greater
transparency of funding; a public registry for all drug trials;
and a re-weighing of current prevention vs. future risk."
Many experts argue that there is a place
for HRT in women's health and you can't look back with a
2005 perspective. That there are huge pros and cons
on either side - it must be an individual choice. I
certainly agree that HRT must be an individual choice as
my bottom line is pro- "don't be miserable". I
would hate to see hormones unavailable for those women who
truly need them. However, the report brings up a very
valid point -- let's not forget that for years menopause
was touted as a "deficiency disease" and only
long term use hormones would keep us younger looking sexually
active and healthier. It didn't come from nowhere.
http://msnbc.msn.com/id/8759578/
http://drkoop.com/newsdetail/93/527345.html
Newsletter
August 2005
HRT AND INCONTINENCE
I’m surprised that this finding didn’t receive more play in the press
as most women heading into menopause fear two symptoms the most -- any kind of
incontinence or weight gain. To this day, HRT is being prescribed for women who
experience incontinence. Published in the Journal of the American Medical Association
(JAMA) and written by WHI researchers (part of the study that pulled women off
HRT a couple of years ago they looked at any symptoms of urinary incontinence
occurring within one year of initiating HRT vs. placebo. Data from 23,300
women, ages 50 to 79 were looked at. Taking estrogen alone is the culprit. Developing
stress incontinence (coughing, laughing, lifting) DOUBLED, urge incontinence
(involuntary contraction of the bladder) increased 32% and overall or mixed was
79%. If women took both estrogen plus progestin, there was no increase
in incontinence but no decrease either, it was the same as placebo. There
are a lot of options besides HRT that a woman can use to address incontinence
of varying from behavior therapy to a device – for more information to
about what can be done, go to http://www.nafc.org/about_incontinence/
For more info on the study go to:
http://health.ivillage.com/gyno/0,,wbnews_7drp3jpx,00.html?arrivalSA=
1&cobrandRef=0&arrival_ freqCap=1&pba=adid=14301812
http://jama.ama-assn.org/cgi/content/abstract/293/8/935
Newsletter March
2005
THE SO-SO NEWS
Just to be clear, we at Oöna Health are not anti-HRT.
We just believe HRT is not the fountain of youth it was touted
to be and shouldn't be the first choice for relief -- there
are risks involved and other lifestyle choices that can made
(like Oöna ) that make it unnecessary. We know there
are women who have tried everything and are still miserable
- if HRT is what it takes, we are all for the quality of
daily life. It doesn't need to be forever. Having said that,
HRT is a big business -- so it comes as no surprise that
there's a new angle. It may hold some merit, there is nothing
definitive here but it is interesting. Researchers looked
closer at the data of two major studies - the Nurses Health
Study which is an epidemiological study and the Women's Health
Initiative, a double blind study -- both had different outcomes
when it came to HRT use and heart attacks. The Nurses Health
Study showed a benefit and the WHI study showed a risk. Upon
this review, the authors have a theory to explain this difference
-- if a woman begins taking hormones right around menopause
and up to 10 years after menopause there is a heart-attack
risk benefit. After 10 years there's a risk. The risk of
blood clots and stroke are unchanged.
This is certainly something to be explored
as there very well may be a "window", but according
the Wall Street Journal, the North American Menopause Society
(NAMS) has already changed their HRT recommendations -- they
now strongly support the notion that the age a woman starts
taking hormones is really what matters with no time limit.
After the WHI study was released, their recommendation was
that hormones should only be used for the shortest duration.
What NAMS doesn't point out is that that
the most compelling point upon review of the data -- a healthy
lifestyle of exercise and diet is the most powerful predictor
of a low risk of heart problems and other health problems
-- hormones or no hormones.
I read the HRT position statement on NAMS
and if you look at the panelist "consulting fee"
disclosures, well… there can be little doubt of "golden
handcuffs", with a strong dose of CYA - just in case
this doesn't pan out.
Newsletter November
2004
HRT AND COLORECTAL CANCER
In the summer of 2002 when researchers stopped the estrogen-progestin
arm of the Women's Health Initiative study, one of the benefits
they reported to HRT was that women had a lower overall risk
for developing colon tumors. The latest study published in
the New England Journal of Medicine in March makes this benefit
a little less clear. This study reports that women on HRT
were diagnosed at a later and more deadly stage of the disease.
HRT users are less likely to catch it early. Researchers aren't
exactly sure why the cancer had advanced further but they
suspect that symptoms associated with the disease were wrongly
attributed to less serious causes. The recommendation is for
women on HRT get routine bowel screenings but many ignore
this advice because it is so unpleasant. For more on this
see http://www.drkoop.com/template.asp?ap=93&page=newsdetail&id=517741
http://content.nejm.org/cgi/content/abstract/350/10/991
Newsletter April
2004
LATEST NEWS ABOUT HRT AND BREAST CANCER
With more study results coming in, a lot of the concerns that
halted the Women's Health Initiative Study last year are beginning
to be confirmed. One study involved about one-fourth of the
British women between the ages of 50 and 64 who were invited
to take part at the time they were scheduled to have a regular
mammogram. One-half of these women were taking hormone replacement
therapy. The results were that HRT can double the risk of
breast cancer. One in 50 women who take combined HRT pills
and patches continuously from the age of 50-60 will develop
breast cancer as a result of this therapy. Women who took
hormones since 1996 when the study began had a 66% chance
of developing cancer and a 22% greater risk of dying from
it. The risks increased over time, so the longer a woman is
on it, the greater the risk. Women who took estrogen alone
(it is assumed with a hysterectomy) had less risk at 30%.
To read the study yourself, go to http://www.thelancet.com/journal/vol362/iss9382
/full/llan.362.9382.talking_points.26784.2#top
Newsletter
September 2003
LATEST NEWS ABOUT HRT AND HEART ATTACKS
The New England Journal of Medicine reported on an HRT study
that was stopped because the risks outweighed the benefits
of having a heart attack. The biggest concern was in the first
year of treatment, when according to the report, the therapy
increases the risk of heart attack by 81%. It levels off,
so that after 5.6 years, the length of the study the increased
risk is 24%. Since last years news, there's been a lot of
speculation that the heart disease risk may be limited to
older women or that there may be pockets of women (more estrogen
deficient) that may benefit from hormone replacement. The
researchers looked at these and many other factors including
ethnicity, education, use of aspirin etc. and there does not
appear to be any group of women who will benefit from the
therapy for heart protection. For access to the study go to
http://content.nejm.org/cgi/content/abstract/349/6/523
Newsletter
September 2003
NEW RISK IN PREMPRO
On June 25, 2003, the Wall St. Journal reported that the most
recent analysis of data from the WHI found that even short-term
use of Prempro can increase the risk of breast cancer and
cause abnormal mammograms. The report found that women taking
Prempro after only three years had a 24% higher incidence
of breast cancer than women taking a placebo. Abnormal mammograms
increased in the treated group even during the first year;
it is believed that HRT increases the density of breast tissue
and therefore can make mammograms more difficult to read.
This translates into a one-in-25 chance of an abnormal mammogram
or that four women in 1,000 would develop cancer that they
wouldn't ordinarily have developed. Doctors stressed that
all told the frequency of breast cancer for the women was
modest: with over 7,000 women in each group, 245 women on
Prempro developed breast cancer and 185 taking sugar pills.
Newsletter
July 2003
MORE BAD NEWS SURFACES ABOUT HRT
For many years health care professionals believed that hormone
replacement therapy would help retain cognitive function in
older women and prevent Alzheimer's. If any one knows where
this theory came from, your author would really like to know.
In any case, it appears that theory is now proven wrong. In
the May 28th issue of JAMA, the journal published the latest
findings based on a four year experiment involving 4,532 women
at 39 different medical centers. In four years, there were
40 cases of dementia in the hormone group (Prempro) and 21
in the placebo group. The conclusion is that hormone therapy
nearly doubled the risk of Alzheimer's disease and other types
of dementia in women who began the treatment at age 65 or
older. The implications for younger women are not known. It
is also not known how different the results would be for women
who take estrogen alone. For more info go to: http://www.nytimes.com/2003/05/28/health/28HORM.html?ex=
1055138996&ei=1&en=6490b0224dcf3478 or, http://jama.ama-assn.org/cgi/content/full/289/20/2651
Newsletter
June 2003
FOR THOSE WHO WONDER HOW TO GET OFF HRT:
Many of us women look to Susan Love, MD not only for her research
but for her honest and open advice. Click here for her suggestions
about how to get off HRT. http://www.susanlovemd.com
Newsletter
January 2003
FRANKLY…
This week in the New York Times, Jane Brody breaks down the
results and controversy of science and recent findings on
hormone replacement therapy. Click on the link below for the
full text, and look on the right for an interactive chart
about the dangers of HRT, as well as links to other articles
on women's health.
http://www.nytimes.com/2002/09/03/health/womenshealth/03HORM.html
Newsletter
September 2002
That's it for this month! As always,
check out our website for lots more information at www.oonahealth.com. In Good Health,
The Oöna Team
Questions or comments? Write valerie@oonahealth.com
|
