15: Hormone Replacement Therapy: What To Know!
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In this episode, we covered:
- Ramifications of low hormones
- Health benefits of replacing hormones
- Different terms for hormone replacement therapy
- Difference between bioidentical and synthetic hormones
- Fears about hormone replacement therapy
- Women’s Health Initiative Study
- Contraindications for HRT
- Over-the-counter hormones vs. prescription
- FDA-approved vs. compounded
In last week’s episode, I shared my journey with hormone replacement therapy and why I use it. If you haven’t listened to that, I highly recommend you go back and do so.
Today, I want to dive a bit deeper into hormone replacement therapy, because there’s a lot of controversy around it.
Hormonal Decline
As you’ve learned by now, hormones start declining in your mid-30s, starting with progesterone, often along with DHEA. Testosterone starts to decline — although for some women, they may experience a surge, followed by a decline. And at some point, estrogen starts to fluctuate wildly, before it starts to decline one to two years prior to menopause, when you’ve stopped getting a period for twelve consecutive months.
Because of the decline in these hormones, women not only begin to experience bothersome symptoms, but they have an increased risk for developing chronic diseases, such as heart disease (which is the #1 killer of women in the US), obesity, different types of dementia such as Alzheimer’s, osteoporosis, and cancers.
Replacing what’s lost
Women are living longer, so if you start perimenopause in your 40s, that’s a whole lot of time left on this planet in a low hormone state! Hormones are the most potent biochemical molecules you have. Think of them as chemical messengers that carry vital communication between glands, organs, and other hormones throughout the body.
When your hormones are not communicating properly or when they’re out of balance, you’ll experience symptoms and your health will suffer.
There comes a point when it’s advisable to replace what’s lost, in order to feel and look your best as well as improve long-term health. This is referred to as hormone replacement therapy.
The terminology around HRT
You’ll likely hear me use the terms HRT (hormone replacement therapy) or BHRT (bioidentical hormone replacement therapy) interchangeably. Some practitioners refer to it as body identical hormone therapy, as well as MHT (menopause hormone therapy). But I find that confusing for some women, because it indicates you have to wait until you’re in menopause to use it and that’s not true, as I mentioned in last week’s episode.
Misconceptions and Safety Concerns of HRT
Whether I say HRT or BHRT, please know I’m referring to bioidentical hormones, which have the exact molecular structure of the hormones produced in your body. They are plant based, made from hormones found in plants.
Bioidentical estrogen comes from soybeans and bioidentical progesterone comes from the tubers of wild yams. Testosterone can come from soy or yams. But we won’t get the same benefits from just eating soy or wild yams — they must be synthesized in a lab. Certain foods like seeds or herbs cannot increase hormones. They can help improve symptoms, but only hormones replace hormones.
On the other hand, synthetic hormones, as in hormonal birth control, act differently in the body. They are metabolized differently, cannot be measured using any type of hormone testing, and come with side effects and long-term health ramifications.
While it’s always a woman’s choice, I do not recommend synthetic hormones, especially in this stage of life. Synthetic hormones increase risk of disease, such as dementia, heart disease, stroke, breast cancer, and blood clots.
Unfortunately, many conventional doctors will prescribe them to women in order to minimize perimenopausal symptoms.
But like most medications, they mask the underlying issue — which is a decline in your endogenous hormones – what your body naturally produces!
The Truth About Hormone Replacement Therapy (HRT)
Please don’t let your doctor tell you they are the same. They are NOT. Progestin and ethinyl estradiol are not the same as bioidentical progesterone and estradiol. They are synthetic hormones made of chemicals that do not exactly duplicate the body’s natural hormones.
Debunking Misinformation around HRT
Luckily, BHRT is becoming more mainstream, as more health experts educate on the benefits. However, there is a common misconception that HRT is dangerous and even causes cancer.
And if you use a commercial prescription of estrogen, you’ll see many warnings, including “Box” warnings. Box warnings (also known as Black Box Warnings) are the highest safety-related warnings that the FDA assigns to medications.
Unfortunately, the reason for the fear and these warnings is due to the Women’s Health Initiative, which was a heavily flawed study that prematurely ended in 2002. Here’s the history of the false information that came from that, which unfortunately spread like wildfire:
The Women’s Health Initiative (WHI) Study on HRT
The NIH (National Institutes of Health) funded the Women’s Health Initiative (WHI) study, the largest hormone replacement therapy clinical trial that included over 160,000 women between the ages of 50 to 79. The study began in 1993 and was supposed to run fifteen years across 40 clinical centers nationwide.
The goal of the study was to figure out how to deal with the most common causes of disease and death in menopausal women: heart disease, bone loss, and cancer. The groups of women in the study included:
- women with a uterus taking Prempro® (very popular HRT but is synthetic conjugated estrogen + synthetic progestin)
- women without a uterus taking Premarin® (synthetic estrogen from urine of horses)
- women with and without a uterus taking placebo
Premature Conclusion of the Study and the Reevaluation of HRT
However, the study ended prematurely in July 2002, because interim findings showed an increased risk of stroke, heart attack, and breast cancer with the use of Prempro®.
Results of the study showed that women who had received it were found to have:
- a 26% increased risk of breast cancer
- a 29% increased risk of myocardial infarction (heart attack) or death from cardiovascular disease
- a 200% increased risk of venous thrombotic disease/embolism, deep vein thrombosis, and pulmonary embolism
- a 33% decreased risk of hip fracture
- a 37% decreased risk of colorectal cancer
- but also a reduction in menopausal symptoms
There was NO increased risk of breast cancer found in the women taking Premarin®.
HRT Study Misinterpretation and the Subsequent Fear Mongering:
Here’s the thing: the average age for the women in the study was 62, so the participants had already gone years without having optimal hormone levels, putting them at higher risk for cancer, heart disease, and other diseases mentioned.
Many of the women had one or more underlying health issues, and were already exhibiting signs and symptoms of some of the diseases.
And as if that wasn’t enough, bioidentical hormones were not even used in the study!
The only hormones used were synthetic hormones. But the news media ran with the story that “Hormones Cause Breast Cancer,” which created fear in women and healthcare providers ever since.
Prior to this, about 18 million American women were using HRT, but because of this faulty study, that number went down to less than 2 million women. It’s mind blowing and hurts my heart to think of all the women who suffered unnecessarily. This is why we can’t be reactive with medicine or health in general. It’s not black and white and fear should never be the driver.
Retraction and Clarification
Luckily, the WHI study committee retracted their statement about hormones and breast cancer. In December of 2019, after a 19-year reanalysis of the study, it was found that women who had been given estrogen replacement therapy had 29% fewer cases of breast cancer, even if they were on estrogen for just a few years. And if they got breast cancer after having been on estrogen for a short period, they had a reduced mortality rate by 44%. They stated that “there is no increased risk of breast cancer, heart attack or stroke”. No apologies or anything, but at least the truth came out.
Though that was not in the news, and many practitioners still fear bioidentical hormones because of the negative publicity it originally received. And years later, we are still doing our best to educate and share the accurate science hoping to quell the fears of women and doctors.
Peri, Menopause and HRT Expert Insights
Someone who I love to learn from is Dr. Rosensweet of the Menopause Method. He says “we’re all at risk for disease. There are many reasons for this. But women who are given hormones are at less risk for breast cancer, heart attack and stroke than women who do NOT receive hormonal treatment in menopause. And women who have had breast cancer do have an increased risk of recurrence, but those who are treated properly and given hormones are at less risk of recurrence than women who are not given hormones.
If you need more convincing, a great resource to read is the book Estrogen Matters by Dr. Avrum Bluming and Carol Tavris, which debunks the myths about HRT and breast cancer, with tons of sources to back up their claims.
Benefits of Bioidentical Hormone Replacement Therapy (HRT)
Now that we got that out of the way, let’s talk about some of the benefits bioidentical hormone replacement therapy provides:
- protection against cognitive decline & Alzheimer’s disease, heart disease, osteoporosis and osteopenia
- supports more restful, deeper sleep
- has been shown to improve vaginal dryness, pain and urinary incontinence
- protects against autoimmune diseases
- supports reduction of blood sugar issues
- eliminates hot flashes, night sweats
- and improves libido
There are more of course. And despite what you may have been told, bioidentical hormone replacement therapy is safe for most women.
Contraindications and Considerations for HRT
But you may be wondering: are there any contraindications for HRT? Yes, there are a few such as:
1-Active breast cancer – however, after breast cancer, you could be a candidate. And family history of breast cancer is not a contraindication. I highly recommend you check out Dr Corinne Menn on Instagram – I’ll link to her page in the show notes.
2-Recent heart attack or stroke.
3-Recent blood clot – however, after 6 months of a stroke/clot, you could be a candidate. Please discuss your risks vs. benefits with a hormone literate provider.
4-Unexplained vaginal bleeding
5-Severe liver disease
Over-the-Counter vs. Prescription HRT
You may have seen over the counter products like progesterone cream, estriol and even estradiol. While they may help alleviate some symptoms, they typically won’t offer the same health protective benefits as prescription hormones because they’re typically low-dose. Now there are some exceptions of companies like Ona’s Natural or Platt Wellness who sell progesterone cream, for example, at 50 mg. But that’s still a pretty low dose. Hormones need to be at optimal levels, in order to reduce risk of diseases, not just symptom management. Regardless, it’s great that there are some options out there if for whatever reason you don’t have access to prescription HRT and need some help managing perimenopausal symptoms.
Compounded vs. FDA-approved hormones.
Unfortunately, due to more misinformation, these two are often pitted against one another. Many people believe compounded hormones are not regulated, which is false.
Compounded medications are made with FDA-approved active pharmaceutical ingredients (known as APIs) from FDA-registered and GMP (stands for Good Manufacturing Practices)-regulated facilities.
They all have standards for quality, purity, strength, packaging, etc. for substances and any other ingredients used in compounded hormone formulations. Federal and State laws regulate all pharmacies, including compounding pharmacies. Individual states and the FDA do regular on-site inspections with safety checks on compounding pharmacies.
The difference between Compounded and FDA-approved hormones
FDA-Approved hormones contain “Inactive ingredients” or excipients and can make up more than 50% of a medication and labels don’t list the amount of each ingredient.
This could be problematic, because many contain allergens such as peanut oil, lactose, dyes, or gluten, which many people cannot tolerate. Lastly, many FDA-approved medications are manufactured outside of the U.S., where they aren’t regulated the same way.
Now, the FDA approved commercial bioidentical hormone therapy options are available at standard chain pharmacies, many are covered by insurance and they’re easily accessible to most people. They’re available in a variety of forms such as tablets, creams, vaginal inserts, patches or gels. Most of the estrogen options only contain estradiol (without estriol, another form of estrogen), and only come in a handful of doses. For example, the FDA-approved bioidentical progesterone is only available as 100 or 200 mg doses. So that makes it difficult to fine tune your dose if say you need 150 mg.
On the other hand, compounding pharmacies have specialized pharmacists who formulate custom prescriptions, without the use of additives, dyes, or chemicals. You can get a variety of HRT forms such as oral, topical creams, injections, pellets, as well as more formulations, including combination estradiol + estriol, known as Biest. Some providers recommend that over estradiol alone.
As I shared in last week’s episode and at the time of this recording, I personally take some FDA approved HRT, as well as compounded HRT.
I’ll leave you with this:
OK, I know that was a lot of information. So listen to this podcast again if necessary.
Starting HRT is a personal choice, depending on your comfort level, needs, budget and preference. When making any decision about your health, it’s important to get educated and weigh the benefits vs. risks with a trusted provider.
And lastly, hormone production, communication, and metabolism, which is the breakdown of your hormones, requires nutrients! This includes minerals like magnesium, iodine, zinc, selenium, and B vitamins. So many of us are missing essential nutrients due to a nutrient-void diet, stress and gut imbalances, so we may struggle with hormone production, communication, and the detoxification of hormones.
This is why we do what we do in The Hormone Rescue Program. We educate you, but we also utilize blood work and functional testing like the HTMA which is mineral testing and GIMAP stool testing to assess your nutrient status, address imbalances and make sure your gut is in tip top shape, so you can properly metabolize hormones, whether or not you’re on HRT. May enrollment for THR is opening soon, so learn more about it at the link in the show notes. Talk to you next week.
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REGISTER HERE – claudiapetrilli.com/masterclass
WORK WITH US: The Hormone Rescue Program
Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780820/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683316/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7475284/
https://www.womensinternational.com/wp-content/uploads/2021/11/Female-Hormone-Chart.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415400/
Claudia Petrilli is a Functional Health Coach, Integrative Nutrition Coach, Women’s Health Educator, and creator of The Hormone Rescue program. Having experienced debilitating periods, digestive issues, a sluggish thyroid, a pituitary tumor, and perimenopause symptoms in her late 30s, she knows exactly what it’s like to get dismissed by doctors and spend years searching for answers.
To connect with Claudia Petrilli:
FREE GIFT: Peri-What?! The Must-Have Guide for Navigating Hormone Changes in Your 40s
WORK WITH US: The Hormone Rescue Program
QUESTIONS? EMAIL: claudia@claudiapetrilli.com
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