Hi, Hormone Hotties, I know, one of the confusing topics in the world of perimenopause/menopause is hormone therapy. What is it? Who should take it? What does it do? What are the risk? So this week's blog I thought I could answer some of these questions. I am warning you there is a lot to chew on this week so hang in there with me. And if you are just finding my blog for the first time and you are wondering why you should listen to me, I'm Dr. LaKeischa an Integrative Gynecologist, hormone specialist, and Best Selling Author. I help women who are struggling with depleting hormones get their hormones balanced, regain mental sharpness, have energy to last all day, and remember how beautiful and vital they are.
The history of the social construct of menopause through the centuries brought us to a point where finally there was recognition that this time in a woman's life was indeed due to a physiological deficiency. But it took a literal act of the 101st Congress in 1990 for the Women's Health Research Act to amend the Public Health Service Act and establish withing the Ofice of the Assistant Secretary for Health the Office of Women's Health. this office was to coordinate all activities and research of the Department of Health and Human Services relating to disease, disorders, or other health conditions that are unique to, more prevalent in, or more serious for women, or for which risk factors or interventions are different for women. (S.2961 - Women's Health Equity Act of 1990)
I'm about to rattle off a lot of acrynyms so buckle up Hormone Hottie and we'll get through it together. The NHLBI (National Heart Lung, and Blood Institute), NIAMS (National Institute of Arthritis and Musculoskeletal and Skin Diseases), NCI (National Cancer Institute), NIA (National Institute on Aging) all got together to look at the leading causes of morbidity and mortality in postmenopausal women. The culprits of these morbidities and mortalities were cardiovascular disease, osteoporosis, and certain cancers. And so the Women's Health Initiative (WHI) was born.
There were 3 components to this initiative:
1. Randomized Control Trial of HRT and its role in preventing cardiovascular disease, osteoporosis, and decreasing certain cancer risks.
2. Observational Study
3. Community prevention study
Now that we have the foundation let's look at 3 easy categories in which to break down the study and what it means for YOU. To clarify, the remainder of this blog is going to address the first component of the initiative, the Randomized Control Trial looking at HRT.
#1: How were the women randomized
Estrogen + Progestin
There were 16,608 women ages 50-70 with an average age of 63 were enrolled in this group. If a woman had a uterus she was put in the group that was given CEE (Conjugated Equine Estrogen) + Medroxyprogesterone Acetate. This is known as Prempro. This hormone therapy was made with estrogen found in the urine of a pregnant horse. Yes, you read that correctly, horse urine.
Estrogen only
In this group, there were 10,739 women. The ages were the same as the E+P group. Women who did not have a uterus were placed in this group. In this group, the thought process was that in light that women didn't have a uterus they didn't need the protection that progesterone is known for providing the uterus when it is exposed to estrogen.
#2: What was the outcome in each group?
The study was supposed to conclude after 8 years but the study was stopped at 5 years. The reason you ask? Well, there were some outcomes that happened that the researchers were not intending to see (did you hear that suspenseful music too?). So what did you see you ask? Let's find out.
Estrogen +Progesterone group:
This group showed an increased risk of heart attack, strokes, blood clots, and breast cancer. The conversation around these increased risks can get tricky in casual conversation. When it comes to translating the numbers from statistical jargon to daily conversation the risk of heart attack, stroke, and blood clots was significant. However, the increased risk of breast cancer was not significant over your baseline risk of being a woman. This is really hard to digest and understand because ANY case of breast cancer is not acceptable. But we need to understand that even synthetic hormone therapy doesn't increase your risk even more.
The positive outcomes that were gathered were decreased risk of fractures due to osteoporosis.
Estrogen only group:
This group seemed to have an increased risk of stroke and blood clots in the lung (Pulmonary embolism, PE).
The positive outcome showed when added to progesterone estrogen seemed to have a protective effect on breast cancer because there was no increased risk. Also, there were symptoms of menopause like hot flashes, night sweats, vaginal dryness that were resolving but had not been considered as endpoints in the initial setup of the study.
#3 What's next?
So here is where the confusion comes. Because the average age of the women in the study was 63 years old it's not right to extrapolate what to do for women in their 40s and early 50s who are experiencing perimenopause and still having periods, even if their periods have become irregular. I would venture to say it is not best practice to extrapolate the findings in this study with women that are menopausal. There was also the unanswered question of what do we do with the women whose menopausal symptoms were improving and they were being able to function again. In response to the bad press and the inability to have clear conversations with women there emerged consensus statements, such as "lowest dose, for the shortest amount of time". Even with this practice, when women were taken off of their therapy their symptoms came back with a vengeance. And women were told, "it will pass", "wait it out", "that's just the way it is", "this is what aging for women is all about".
What's next?! What's next is women saying there has to be a better way. What's next is understanding and teaching about options like adaptogenic herbs, supplements, restorative practices, bioidentical hormones, and accessibility to those hormones through compounding pharmacies. What's next is women being taken seriously when their labs show elevated cholesterol, rising HgA1C, and weight gain (signs of metabolic syndrome and inflammation) and they say they ARE doing all the things their doctors tell them to do but it still isn't working. What's next is for women to not be put out to pasture of sorts when they pass the reproductive time in their lives. What's next is for the continued fight for women's health. What's next? Keep asking that question so that women for generations to come will be empowered when it comes to their health throughout all the stages of their life. And that's what I call a Hormone Hottie.
