This is an important study in that it highlights some important physiological principles. When you swallow a hormone, up to 90 percent of it is broken down in your liver. Your body may not like these breakdown products, and it might experience significant unwanted reactions from them.

When your body makes hormones it secretes them directly into your blood. This is why applying hormones through the skin makes much more sense than swallowing them.

Additionally, it is important to recognize that estrogen is not necessarily evil or to be avoided at all costs. There is tremendous confusion in this area, especially from traditional medical doctors.

There are two situations where I routinely recommend estrogen to women. The first is when they have a surgically induced menopause and have their ovaries removed. The other, which is nearly as important, is when women cannot sleep at night due to hot flashes, and they fail to respond to conservative treatments like black cohosh, a natural progesterone.

If a woman continues to have interrupted sleep it is highly likely she will get depressed at some point from lack of sleep. Depression can be a devastating disease, and I believe it should be avoided if at all possible. I believe the risk from the estrogen is less significant to a person’s health than that from the potential depression.

I have had a few patients come in recently whose doctors would not prescribe estrogen for them based on the study that was published last year. The primary problem in this study was that ERT was used and the estrogen was given as PremPro, which includes synthetic progesterone.

So a primary recommendation is to restrict hormones to natural ones and avoid the synthetics.

However, even using natural hormones can get you into trouble. I was recommending natural progesterone cream for many years before I realized that it was causing a problem. I would routinely find that when I measured the progesterone levels of patients using the cream, they were elevated. It is beyond ridiculous that the companies that do the testing of these creams actually change the reference range to imply that the elevated levels of someone who is on the creams are normal.

I hardly ever advise hormone creams at this time.

I have switched to using sublingual (under the tongue) preparations as I think they are far safer and less likely to cause elevated hormone levels.

The study discussed above, however, does use a transdermal (skin) patch. I have not found these to be a problem, and if I use estrogen I have tended to prescribe the commercially available patches for ease of convenience and insurance coverage reimbursement issues.

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