There is More to HRT than Replacing Estrogen

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This week, Brett Newcomb and I discuss several misunderstandings regarding hormone replacement. There are many misconceptions regarding this kind of treatment, many of which are introduced by sensationalist media that is misinformed, themselves. We attempt to debunk some of these misunderstandings in this week’s podcast.

This week, Brett Newcomb and I will be discussing the terms Hormone Replacement Therapy (HRT) and Estrogen Replacement Therapy (ERT), and what is meant by the term “hormones”. We are concerned because so many women are still confused about how the term “hormone” is generalized to mean estrogen when, in reality, “hormone” can be any one of a hundred substances made by the body. Because of this generalization and conflicting research, women have been scared into a state of immobilization. When we can’t trust what we read or hear, we are led into making poor decisions which results in most women not receiving anything to replace their estrogen, testosterone, and progesterone when they enter their 40s.

First, ERT means that the patient is only getting estrogen of some kind (estradiol, synthetic estradiol, estrone, estriolm, or Premarin—estrogen from horses,) but is not receiving progestins, usually because they have had a hysterectomy.

HRT means that the patient is receiving estrogen of some kind and progestin, usually Provera. This is added to estrogen to protect the uterus from bleeding and to prevent uterine cancer.

Now for the falsehoods and generalizations: Many women, and even their doctors, still believe that replacing estrogen after menopause will increase their chance of developing breast cancer. This was the report from one study in 2002 by WHI, which has been re-visited and found to be a poor study, misrepresenting the risks of estrogen. The real findings were that estrogen-alone ERT, did not increase the risk of getting breast cancer and, in fact, the study group on ERT had fewer cases of breast cancer than the group who took nothing. This initiative was cancelled before it was finished and its conclusions were widely broadcast because the researchers felt that they had uncovered a major risk for women who were receiving HRT. The increase in breast cancer was among the HRT group who were taking progestins with their estrogen. So, it was really progestin that was the problem. I discuss this in detail in our book The Secret Female Hormone, if you want the whole story.

The researchers generalized their findings to the headline, “Hormones Cause Breast Cancer,” which did not accurately describe the results of the study. In reality, the dangerous hormone was one specific synthetic hormone—progestin, specifically Provera. The news media ran wild with the story, shouting everywhere that the sky was falling, and women taking estrogen would get breast cancer. In the end, this one misleading study had negated the thousands of studies before it that found that estrogen replacement did not cause breast cancer. All of this was an overreaction and an erroneous conclusion of a poor study.

Researchers and Journalists alike forget sometimes that they have a responsibility to the public to refrain from “crying fire” in the proverbial crowded theater, and in their rush to make everyone safe, they did a great disservice to women. Menopausal women went without their needed ERT and HRT for almost 9 years before the truth was publicized, but the damage had been done and many women died or became non-functioning because they stopped their hormone replacement. What had been rapidly becoming a standard of care in the 1990s, replacing estrogen for women who became menopausal, was quickly abandoned in order to avoid the falsely-publicized risk of cancer with estrogen. By stopping their HRT, thousands of women developed osteoporosis, depression, anxiety, dry vaginas and painful intercourse, hair loss, heart disease, dementia, and Alzheimer’s. Diabetes, and other diseases that had been prevented by ERT while they were replacing lost estrogen began to resurface.

A retraction is never as motivating as a headline, therefore it has taken almost 12 years to re-establish the standard of care for women. But, the damage from the slander of HRT and ERT remains because many doctors still won’t provide hormone replacement for those women who need it.

Today, the term HRT is misinterpreted by most women as “dangerous estrogen.”  My practice, and the centerpiece of our book The Secret Female Hormone, is the evidence that replacement of bio-identical, non-oral testosterone can improve the lives of women over 40 with or without ERT/HRT. I believe that testosterone should be included in the term “HRT,”  as a vital hormone that declines after 40 and takes our body, sex life, and soul away with it. If a woman replaces testosterone and estrogen, she can regain much of the vigor, body composition and health of her youth. Women can replace this hormone—testosterone—without risk of breast cancer. So, if you are still concerned by the WHI study but need hormone replacement, you can opt for non-oral testosterone replacement. Even women with breast cancer can take testosterone.

When replacing estrogen of any type, there is a small risk of uterine bleeding. In general, uterine bleeding from HRT after menopause is a benign and irritating problem. However, it can occasionally be a sign of uterine cancer. Bleeding must be investigated after menopause but it is not a good reason to avoid replacing estrogen. The benefits greatly outweigh the risks of uterine bleeding or uterine cancer.

The normal GYN treatment for post menopausal bleeding is adding progesterone to balance the estrogen replacement given. However, if this doesn’t work to stop the bleeding, an ultrasound of the uterus and possible a uterine biopsy, or D&C are the tests involved in diagnosing the cause of bleeding. The possible causes are uterine fibroids, polyps, adenomyosis, endometrial hyperplasia, and endometrial cancer. Lining of the uterus is benign. Most can be treated and won’t recur.

Please do not reflexively reject ERT, HRT, or testosterone replacement because of fear. Weigh the benefits of replacing estrogen and testosterone with the risks of these replacement. But also consider the diseases of aging that you are at risk for when you choose to reject  the replacement of estrogen and testosterone.