HRT, Is It Right For You?
Three different types of estrogen hormones are manufactured by the human body, estrone, estradiol, and estriol.
Of these, estradiol is the strongest and most significant prior to menopause. It is also the most widely used in hormone replacement therapy to treat hot flashes, night sweats and other menopause symptoms. Estrone and estriol are also use in some treatments.
Estrogens and progestins (also used in HRT) are made in different ways.
Estrogens made from pregnant horse urine are called conjugated estrogens and are the oldest type of estrogen used in HRT. Estrogens made from plants are called esterified estrogens (sometimes using yams and soy plants). Estrogens formulated in the laboratory are referred to as synthetic estrogens. Several progestins are used in HRT. Again, most of these are formulated in the laboratory.
In the past, hormone replacement therapy (HRT) was widely recommended for the treatment of menopause and menopausal symptoms as well as in the prevention of osteoporosis and heart disease. Hormone replacement therapy is used to supplement the body with either estrogen alone or estrogen and progesterone in combination during and after menopause.
Estrogen and progesterone are hormones that are produced by a woman's ovaries. When the ovaries no longer produce adequate amounts of these hormones (as in menopause), HRT can be given to supplement the body with adequate levels of estrogen and progesterone.
Estrogen and progesterone together thicken the lining of the uterus, preparing it for the possible implantation of a fertilized egg. Estrogen also influences how the body uses calcium, an important mineral in the building of bones, and helps maintain healthy levels of cholesterol in the blood. Estrogen also keeps the vagina healthy.
As menopause nears, the ovaries reduce most of their production of these hormones. Lowered or fluctuating estrogen levels may cause menopause symptoms such as hot flashes, and medical conditions such as osteoporosis. Hormone therapy helps to replenish the estrogen, relieving some of the symptoms of menopause and helping to prevent osteoporosis.
Progesterone is used along with estrogen in women who still have their uterus. In these women, if taken without progesterone, estrogen increases a woman's risk for cancer of the endometrium (the lining of the uterus). During a woman's reproductive years, endometrial cells are shed during menstruation. When the endometrium is no longer shed, estrogen can cause an overgrowth of cells in the uterus, a condition that can lead to cancer.
Progesterone reduces the risk of endometrial cancer by making the endometrium shed each month. As a result, women who take progesterone may have monthly bleeding. Monthly bleeding can be lessened and, in some cases, eliminated by taking progesterone and estrogen together continuously. Women who have had a hysterectomy (removal of the uterus through surgery) usually do not need to take progesterone.
There are two main types of hormone replacement therapy. The first involves taking estrogen alone (Estrogen Therapy). Doctors most frequently prescribe a low dose of estrogen to be taken as a pill or patch, each day. Estrogen can also be prescribed as a cream. Due to the inherent risks, only the lowest dose possible (to mitigate menopause symptoms and to prevent osteporosis) should be taken.
Combination Therapy (Progesterone/Progestin-Estrogen Hormone Therapy) combines doses of estrogen and progesterone (progestin is a synthetic form of progesterone). Estrogen and lower dose of progesterone also may be given continuously to prevent the regular monthly bleeding which can occur in HRT. Again, it is currently recommended that only the lowest dose possible, for the shortest duration be administered due to the inherent risk factors.
Both treatment types should be reevaluated at a minimum of an annual basis, or sooner, should concerning symptoms manifest.
HRT is most often prescribed to relieve menopause symptoms, including hot flashes, vaginal dryness, night sweats, dry itchy skin, and mood swings. Other possible benefits may include the reduced risk of developing osteoporosis, bone breakage, and tooth loss.
While HRT helps many women get through menopause, the treatment (like any prescription or even non-prescription medicines) is not risk-free. Known health risks include:
- An increased risk of endometrial cancer (if a woman still has her uterus and is not taking progesterone along with estrogen).
- Greater risk of ovarian cancer. The “Million Women” study showed that over 5 years, for every 3,300 women who take HRT, one extra woman will die due to ovarian cancer. The longer HRT is taken, the more the risk ovarian cancer increases.
- Greater risk of breast cancer. Woman taking combined HRT have double the breast cancer risk of women who don't take HRT. The longer you take HRT, the more your breast cancer risk increases. With prolonged use, HRT can cause an increase in breast cancer by as much as 40%. Overall, starting estrogen-progestagen therapy soon after menopause appears to boost the risk of breast cancer, even when only used for short periods of time. Women who began the therapy in the three years after menopause and took it for two years or less had a 54% higher risk of breast cancer compared to those who never used the therapy.
- Increase risk of blood colts and stroke. Researchers reviewing data from eight observational studies and nine randomized controlled trials found that women taking HRT were between two and three times more likely to develop a blood clot, and that the risk was significantly higher during the first year of treatment. Also, HRT is associated with an increased risk of Venous Thromboembolism (VTE), a blood clot in the vein which can be fatal.
- An increased risk of heart disease. In a study of nearly ¾ of a million women, 24% were found to have a higher incident of heart disease than those not taking HRT.
- Greater risk of contracting cataracts. An eight-year prospective study of more than 30,000 postmenopausal Swedish women found that those who were using or had used HRT had significantly higher rates of cataract removal, compared with women who had never used HRT.
- Increased risk of gallbladder disease. Data from the “Million Women” Study found that compared to women who had never taken HRT, all women using HRT had an increased risk of developing gallbladder disease.
- Increased risk of Asthma. One study suggests that compared with women who have never used any form of HRT, those who do use it are at a 21% more likely chance to develop asthma.
In addition to the life-threatening HRT risks noted above, other HRT side effects have also been noted. These include monthly bleeding, irregular spotting, breast tenderness, fluid retention, Headaches (including migraines), dizziness, skin discoloration (brown or black patches), increased breast density (making mammogram interpretation more difficult), and skin irritation (under the estrogen patch).
HRT should never be considered by women who have active or past breast cancers, recurrent or active endometrial cancer, abnormal vaginal bleeding, recurrent or active blood clots, a history of stroke, liver disease, heart disease, known or suspected pregnancy, or who use tobacco in any form.
Following the preponderance of evidence related to the negative effects of HRT, most women discontinued treatments. Findings show that most women have not returned to alternate treatments or new drugs.
Many women have changed their attitude related to menopause symptoms, and not wishing to treat this natural progression of their lives as a disease (that needs to be treated), are refusing to use any pills, patches or creams to ease these symptoms.
Some women are investigating natural plant-based menopause treatment options. These biomedical options (not to be confused with laboratory produced esterified estrogens) show real promise and are extremely safe (especially when compared to traditional HRT).
Especially so are the phytoestrogens found in flax-hull lignans, a concentrated form of phytoneutrients prominent in the outer hull portion of the flax seed.