By Dr. Mercola
The US Preventive Services Task Force recently published its draft recommendations on hormone replacement therapy1.
While the task force has previously sparked controversy with its recommendations for breast cancer and PSA prostate cancer screening, their recommendations for hormone replacement therapy for menopausal women taking hormones to prevent chronic disease has been met with little resistance.
The group is changing its recommendations for menopausal women who use hormone therapy, either estrogen alone, or in combination with progestin to prevent heart disease, osteoporosis, and cognitive decline.
They are accepting public comments on the draft until June 26, at which point the group will decide whether to make the draft recommendations final. According to a recent report by CNN2:
"... The task force recommendations "are aimed at older women, who are generally healthy asking, 'If I take a pill a day, will I prevent a heart attack?" [Dr. Carolyn] Crandall [professor of medicine at the David Geffen School of Medicine at UCLA] said.
... In the face of pretty good evidence, the balance of potential benefits and potential harms leads us not to recommend the use of these therapies," said Dr. Kirsten Bibbins-Domingo, a task force member.
The proposed recommendations do not apply to women younger than 50 who have undergone surgical menopause or who are taking hormone therapy to manage menopausal symptoms such as hot flashes, according to the panel.
... "The balance of benefits or harms may be different with young women, so you can't say this absolutely applies to younger women making hormone therapy decisions," Crandall said."
HRT as Preventive Strategy against Chronic Disease Not Supported by Data
The task force based their new recommendation on a recent review of the results from nine clinical trials published over the past decade3. The main question the group sought to answer was whether or not hormone replacement therapy (HRT) should be used by otherwise healthy menopausal women "to prevent a hypothetical future health event such as heart disease or cognitive decline." Alas, according to the task force, "There is no evidence that the therapies would prevent those conditions4.
However, I would point out that this analysis is based on the use of synthetic hormones, not bioidenticals, which I'll discuss more in a moment. That said, according to the featured CNN article:
"Years ago, in addition to providing relief for menopause symptoms, hormone therapy was thought to offer protection against cardiovascular problems, osteoporosis and dementia, so doctors routinely prescribed it to otherwise healthy women. That practice fell out of favor about 10 years ago when a large clinical trial -- the Women's Health Initiative -- designed to confirm these hypotheses was halted early. Women involved in that trial were actually at higher risk for many of the problems that hormone therapy was supposed to prevent."
Indeed, many large-scale trials, including the Women's Health Initiative, have indicated that taking estrogen alone, or the combination of estrogen and progestin, actually increased women's chances of developing strokes, dementia, deep vein thrombosis, urinary incontinence and gallbladder disease.
"The bottom line is clinicians must take all clinical parameters into account for the patient and prescribe the lowest dose for the shortest duration of time," said Dr. Joseph Sanfilippo, vice chairman of reproductive sciences at Magee-Women's Hospital in Pittsburgh, in an e-mail to CNN5."
There are Better Ways to Prevent Heart Disease than HRT
Heart disease prevention is indeed an important concern, but there are far more effective, not to mention safer ways to prevent heart attacks and strokes than using HRT. Key lifestyle strategies that will help protect your heart naturally include:
- Boost your good cholesterol and lower your triglyceride levels: Many people strive to reduce their cholesterol levels to protect their heart, but high levels of good (HDL) cholesterol are believed to be protective against heart disease. Meanwhile, high triglycerides are an incredibly potent risk factor. In combination, high triglycerides and low HDL levels are an even bigger risk; this ratio is even more important to your heart health than the standard good vs. bad cholesterol ratio.
In fact, one study found that people with the highest ratio of triglycerides to HDL had 16 times the risk of heart attack as those with the lowest ratio of triglycerides to HDL.
You can increase your HDL levels by exercising and getting plenty of omega-3 fats like those from krill oil. Triglycerides are easily decreased by exercising and avoiding grains and sugars in your diet.
- Get enough high quality animal based omega-3 fats: Regularly taking a high-quality animal-based omega-3 supplement such as krill oil is one of the easiest ways to help promote your heart health.
- Check your iron levels: If you have excessive levels in your body you are at risk of major oxidation, or premature aging as excessive iron acts as a catalyst to increase your free radical formation though excessive oxidation. Excess iron will also increase your risk of heart disease and cancer. If you are a man, or a woman in menopause, you should get your iron levels tested and, if they're too high, take steps to reduce them. The simplest way to reduce your iron levels is by donating blood.
- Normalize your insulin levels: Elevated insulin levels can lead to insulin resistance, a major risk factor for heart disease. Carefully avoiding sugar/fructose and grains, combined with regular exercise are the most effective strategies for getting your insulin levels back to normal.
- Avoid FAKE Estrogens. These are also called xenoestrogens and are pervasive in modern culture. Non-organic foods are loaded with pesticides and herbicides that have potent xenoestrogenic activity. Addtiionally, plastics have BPS and phthalates and many cosmetics have parabens. It is wise to avoid all of these items as they are potent estrogenic influences which can increase a woman's risk of breast cancer.
- Keep your mouth healthy: Gum disease can trigger heart attacks, so make sure you keep your teeth, gums and mouth clean.
Should You Treat Menopause with HRT?
As stated earlier, the panel's recommendation to avoid HRT is only directed to menopausal women who are using synthetic hormones as a preventive measure. It does not apply to women who are managing symptoms of menopause (such as hot flashes, mood swings, and depression), or younger women who take hormones due to having their ovaries removed (surgically-induced menopause).
In these cases, hormone therapy can still be useful, and in the case of surgically-induced menopause, a necessity. However, it's a complex topic, and synthetic hormone replacement does have its risks, which is why I do not recommend using them. There are a number of different kinds of estrogen: Pharmaceutical estradiol comes from plant molecules modified in a lab, while Premarin and Prempro contain potent horse estrogens that are manufactured from the urine of pregnant mares. All of these are synthetic versions that have their share of side effects.
Can You Believe Drug Companies Used to Pay Me to Promote HRT?
Yes, at one time I was part of the dark side. Many of you may not know this about me, but after finishing my medical residency training in the mid-80s, I was actually a paid speaker for the drug companies. I got paid to fly around the country to lecture physicians about estrogen replacement therapy. At the time, I was convinced it was an ideal strategy for menopausal women because I was manipulated and deceived by the overwhelming "evidence" that was published in the respected peer-reviewed medical journals.
Only decades later would I finally understand the massive corruption and collusion between the drug companies, medical journals and federal regulatory agencies that provided the illusion of scientific legitimacy when the real primary purpose was to increase their sales.
I still believe replacing your hormones can be a good strategy. But in my journey of learning about and truly coming to understand health, I've realized that using synthetic hormones, and even natural hormones from animals, is not a wise choice.
A much better alternative is to use bioidentical hormones. These are natural hormones that are "bioidentical" to the ones your body produces. The bioidentical that is prescribed 80 percent of the time is estriol. It's natural, not a drug, and you get it at compounding pharmacies. It has been used safely for decades, and I believe it's particularly useful when your ovaries have been removed or you've had a hysterectomy.
The Ideal Way to Administer Bioidentical Hormones
Keep in mind that when it comes to administering bioidentical hormones, some delivery methods are clearly superior to others. Oral supplementation is perhaps your worst option, as your liver processes everything in your digestive tract first, before it enters your bloodstream. Any method that bypasses your liver will therefore be more effective. Hormone creams are one common alternative that achieves this. However, since hormones are fat-soluble, they can build up in your fatty tissues and lead to having too much in your body. This in turn can disrupt other hormones. It's also near impossible to accurately determine the dose when using a cream.
That is why I STRONGLY recommend trans mucosal administration. Pleaselisten to my interview at the top of the article with Dr. Wright inwhich we discuss this near the end of the interview.
What to do BEFORE Taking Hormones for Menopause
Natural bioidentical hormones can offer relief from menopausal symptoms, but I recommend not using them as your first go-to option. Treating hormone imbalances requires a whole-body approach; the best approaches are often preventive and involve diet, exercise and other lifestyle-based strategies.
For instance, both estrogen and progesterone are necessary in the female cycle, and their balance is key for optimal health. Many premenopausal women have an imbalance of these hormones. And if you have insufficient levels of progesterone to counter excessive estrogen, this imbalance can be further exacerbated by chronic stress. Therefore, your answer might not necessarily lie in using hormones, but rather addressing your stress levels so that your body can normalize your hormone levels naturally.
Likewise, a healthful diet, low in processed foods (which are high in health-harming sugars/fructose, grains, genetically engineered ingredients, trans fats, processed salt, and other chemical additives) and high in whole organic foods, along with regular exercise, can go a long way to keeping your hormones balanced as you age. It's important to realize that processed foods—all those refined carbohydrates, and processed and heated fats, all serve to raise your estrogen to abnormal levels—as much as twice the normal, which are maintained for the better part of the adult lives of most American women.
This is a MAJOR contributing cause of menopausal symptoms in the first place. Additional strategies you can try before resorting to bioidentical hormones include:
- Phytoestrogens: Consuming plenty of phytoestrogens (plant-estrogens) such as licorice and alfalfa before menopause can also help moderate your day-to-day estrogen levels so that when menopause comes, the drop won't be so dramatic. Just don't make the mistake of using unfermented soy, which can wreak havoc on your health in a number of different ways.
- Optimize your vitamin D levels: This is a must for gene regulation and optimal health. For more information, I recommend you watch my one-hour video lecture on this essential nutrient.
- Polyphenols: Certain polyphenols have also been shown to have some HRT-like benefits without the drawbacks, and are associated with a lowered risk of heart disease. Royal Maca seems to be an amazing adaptogenic herbal solution for menopause that has helped many women. Be sure to avoid the inexpensive varieties, as they typically don't work. If you chose this option make sure to obtain the authentic version from Peru.
- Animal-based omega-3 fat: You'll also want to get plenty high quality animal-based omega-3 fats, such as krill oil.
- Black cohosh: Black Cohosh may help regulate body temperature and hot flashes. In many cases, these lifestyle strategies will be very effective in relieving menopausal symptoms, but in cases where it is not enough, bioidentical hormones may be able to help. However, you'll want to make sure you get your hormonal levels checked properly before embarking on any kind of hormone supplementation program, and work with a knowledgeable health care practitioner who can guide you.
- i US Preventive Services Task Force, Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: U.S. Preventive Services Task Force Recommendation Statement DRAFT, May 2012
- ii CNN May 29, 2012
- iii US Preventive Services Task Force, Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions, A Systematic Review to Update the U.S. Preventive Services Task Force Recommendations, May 2012
- iv CNN May 29, 2012
- v See reference iv