Should you take hormones for menopause
At the onset of menopause, the body undergoes many unpleasant changes that
can have potentially dangerous consequences. With estrogen deficiency being a major player, Dr. Sly Nedic looks at the value of hormone replacement therapy.
One of the most prominent symptoms of menopause is experiencing bothersome hot flushes, which actually drive 75% of all women to gynecologists and other conventional doctors to seek some relief from this unpleasant occurrence.This medical visit then generally results in the prescription of estrogen. The estrogen that gets recommended is a synthetic, non-bio-identical dose that is the same for all women, irrespective of their underlying health issues, body weight, individual differences in estrogen metabolism, etc. This treatment is typically called HRT (hormone replacement therapy).The main indications for conventional doctors to prescribe it is to stop hot flushes and prevent osteoporosis, and it is typically given for a couple of years. Unfortunately, menopausal symptoms are actually very complex and involve numerous systems, functions and organs. Estrogen alone governs 400 functions in the body, so picture the turmoil that happens in the body once estrogen drops substantially.
Symptoms and Causes
Typical symptoms are palpitations, night sweats, mood swings, vertigo, insomnia, depression, anxiety, loss of libido, forgetfulness, brain fog, vaginal dryness, urinary incontinence, painful intercourse, skin ageing, collagen loss, cardiovascular diseases and a higher incidence of stroke, osteoarthritis and joint pain, dyslipidemia, osteoporosis, and hot flushes. Preventing some of these detrimental diseases, as well as improving the quality of life for aging women by essentially providing anti-aging effects should be the main goals of replacing hormones – instead of just a temporary relief from hot flushes.
Menopause is a multifaceted event, transpiring at the same time as the decline of multiple hormones in the blood, including: estrogen, progesterone, DHEA, thyroid hormone, growth hormone, pregnenolone, melatonin, etc. All of these hormones are involved in menopausal pathology, and they usually don’t get replaced by treatments prescribed by conventional doctors. By only replacing estrogen, this, therefore, creates estrogen dominance.
Dangers of synthetic estrogen
The 1990s saw something of a golden era for HRT, which was deemed safe to prescribe, but the publication of the Women’s Health Initiative (WHI) put paid to this belief, highlighting the dangerous effects of synthetic estrogen on women’s bodies. The hazardous effects of HRT are:
- increased risk of myocardial infarction – 29%
- increased risk of stroke – 32%
- increased risk of deep venous thrombosis and pulmonary embolism – 113%
- increased risk of breast cancer – 26%.
Since the WHI study, the concerns of potential HRT users and medical practitioners have grown, with significantly smaller doses of estrogen being prescribed. However, the fear of breast cancer, stroke, deep vein thrombosis and heart attack remains, and the use of conventional HRT is becoming increasingly questionable. These dangerous effects have historically been blamed on progestins (synthetic progesterone was often used concomitantly with estrogen), but the concern remains because of the epidemic increase in hormone-sensitive cancers, especially breast cancer.
A different, safer approach
Integrative and regenerative medicine practitioners have been adopting a rather different approach to treating menopausal women. They have introduced bio-identical hormones/HRT, with the aim of simultaneously replacing all the hormones missing in a women’s body with bio-identical forms. The end goal is to retain a good quality of life and decrease the incidence age-related degenerative diseases.
Bio-identical hormones are active substances present in nature that have an effect identical to our own hormones on a target tissue in our body. Studies have shown that BHRT in physiological doses (equivalent to what your body used to make) produce significantly fewer adverse effects than synthetic, animal-derived hormones present in conventional HRT. Also, the gel or cream application (transdermal) of these hormones helps to override liver detoxification pathways, leading to safer hormone metabolism.
Furthermore, French E3N cohort study concluded that the combination of bio-identical estrogen/progesterone is safer than estrogen alone when it comes to breast cancer risk. Numerous other studies have emphasized the importance of using an estrogen/progesterone combination, targeting a specific ratio in the blood to prevent breast cancer.
Everybody is unique
The ready availability of bio-identical hormones in many practices does not mean, however, that these should be dished out in a conventional, ‘one size fits all’ manner. Knowing that they are safer than their synthetic counterparts does not mean that they are absolutely safe. Let’s look at why this is.
Our body deals with any estrogen as a potential toxin, whether it be our own estrogen, xenoestrogens from the environment (such as phthalates and parabens from cosmetics), estrogen from HRT, and even estrogen from BHRT. Each woman has her own individual metabolism and way of detoxing estrogen that hugely depends on her genetic make-up, methylation capacity, and underlying health issues like inflammation, insulin resistance, heavy metal toxicity, nutritional deficiencies, stress, gut health, environmental toxicity, and so on.
Furthermore, measuring estrogen metabolites can provide a very accurate picture as to how estrogen is detoxified in a women’s body – via favorable or unfavorable pathways. Dangerous estrogen metabolites that get transformed into DNA-damaging quinones can initiate breast cancer. Specific genes – such as COMT, SULT, GSTM, and CYP1B1 – increase a predisposition to the production of dangerous estrogen metabolites involved in breast cancer pathology. The opposite is also true. Women without these genes can also create dangerous estrogen metabolites if they are perhaps nutritionally depleted or lead stressful/toxic lifestyles.
Additionally, hormonal transformation takes place inside a woman’s body and it is possible for testosterone and DHEA, for example, to become estrogen under certain circumstances. This can add to the estrogen burden even without adding any external hormones. Understanding all these dynamics is a pre-requisite in the safe application of bio-identical hormones.
In conclusion, the use of bio-identical hormones could be safe if done in an integrative way, i.e. checking genetic predisposition, urinary metabolites, hormone ratios, multiple hormones levels, identifying nutritional depletion, underlying toxicities, and comprehensive health verification. Only then should hormones be prescribed and combined in a dose that is specifically calculated for individual women.
References available on request.