Nearly every day I see people who are not living at the level of health and vitality that they want for themselves at mid-life and who are looking for shifts and changes that they can make to improve their over-all well-being.The changes that we face in our body’s physiology at mid-life can have profound effects on how we feel, function, and live the remainder of our lives.
The good news is that there are things we can do, at any age, that can greatly change our health and well-being now and into the future.
You may have heard about the recent report of the 10 year review of the Women’s Health Initiative Study (“WHI”) in the professional journal, Climacteric, and its assessment of what we now know. The risks of hormone therapy reported in the 2002 WHI study of women who used Prempro (horse estrogens and synthetic progestin, MPA – as opposed to bio-identical hormones) have now been found to be exaggerated. In addition, those earlier conclusions are now contrasted with current studies that show lower risks if women using estrogen-progestin options with different types of progestins and specifically bio-identical progesterone, estrogen alone (though I see other studies where this is not advised), lower doses of hormones, and non-oral delivery – all of which are very different from what were used in the WHI study.
Melinda Beck of the Wall Street Journal Health Journal stated in the June 4, 2012, issue:
Women who are close to menopause face few dangers from hormone-replacement therapy, and the benefits may outweigh the risks for those who are suffering from severe symptoms.
That’s the consensus of a spate of new analyses clarifying a decade of research since a big study scared millions of women and their doctors away from using hormone therapy at menopause.
The initial WHI finding of increased risk of breast cancer didn’t hold up under closer scrutiny. When the researchers looked more critically at the data, the risk, though present, was actually found to be quite small. They have also acknowledged the effect of the fact that the women in the study were 10 years or more post-menopausal – a time in life when the risks of disease is normally higher. Now, the researchers are speaking of a “window of opportunity” around menopause when women should start hormones to get the most benefit and have the least risks.
Unfortunately, many women have been negatively affected by the scare of the original study of synthetic hormones, and many of them were never given the data about the different outcomes for bio-identical hormones. Bio-identical hormones are replicas of what our bodies produce for estradiol, progesterone, and testosterone, and studies show that they have a different risk profile than synthetic hormones that were the subject of the WHI study.
In 2008, Dr. Agnes Fournier, a researcher at the National Institute of Health and Medical Research in France, published an update in the peer-review medical journal, Breast Cancer Research and Treatment. She studied 80,377 French menopausal women who had taken bio-identical hormones for an average of 8 years (up to a maximum of 12 years). The results showed that there was no increased risk of breast cancer among those who had used bio-identical estrogen and bio-identical progesterone. In contrast, the few women who had used non bio-identical estrogen/progestin combination demonstrated a 69% increased risk of breast cancer. It should be noted that bio-identical hormone replacement therapy is used more commonly in many western European countries.
Issues with the WHI study are finally coming to light in this review of the 10 years since the study
– WHI studied women who were 10 years or more past menopause, who used only synthetic hormones (including progestins which are very different from progesterone), who took them orally, and who did not have the dosing and appropriate lab follow-up procedures to optimize their treatment based on the report.
For the past 10 years, many women have been denied the option of using hormones for menopausal symptoms based on the results of the WHI study. Now, the number of menopausal women on hormone replacement is half of what it was 10 years ago. That means that there are a lot of women suffering from symptoms that could be prevented, and complication risks that could be lowered, by the use of bio-identical hormones.
Despite all of the studies and postulated conclusions, we have to recognize that each of us has our own individualized risks for disease that we must consider when we evaluate the risks and benefits of bio-identical hormones (or any other treatment).
That’s a role I play with my patients – to assess your genetics, current health/disease state, and lifestyle risks and to weigh these in evaluating the risks/benefits of using bio-identical hormones. I help many women and men to become more educated about their options and to become empowered to make their own health decisions at this important time in life. If you haven’t come to one of my lectures on this topic, why don’t you sign up to attend the next one? It’s for women and men, and we cover a lot of these issues. The information to reserve a place at the next lecture is elsewhere in this newsletter.
I applaud the many patients in my practice who ask questions, evaluate their risks and benefits, and make the decision only they can make regarding their therapy – and then see the rewards in their health and quality of life.
Don’t sit on the sidelines in fear when you read something in the media – get the relevant information so that you can make the best decision for YOU and know that I’m here to support you in that process.
Taking steps toward optimal health and vitality every day!
Jane Kennedy, CFNP, MN, MPH
