By Dr. Sanjay Moham Ram
ND & Experienced in Bio~identical Hormone Replacement
Few topics have attracted as much attention in recent years as hormone replacement therapy (HRT) among postmenopausal women and men. For decades, physicians were prescribing patented non-bioidentical estrogen, testosterone and progestin drugs such as Premarin®, Provera®, Prempro® and Androgel® —to combat the symptoms of menopause and andropause. What people don’t realize is that non-bioidentical hormones are not identical in structure or activity to the hormones naturally produced within the body.
Physicians also prescribe non-bioidentical hormones to protect postmenopausal women and men against osteoporosis and heart disease. The rationale behind heart disease prevention was simple: during their reproductive years, women and men enjoy lower rates of heart disease, supposedly because of the protective effect of the hormones. It seemed only logical to mainstream medicine that by replacing the effect of estrogens, progesterone and testosterone lost at as a person ages, with non-bioidentical hormones, women and men would retain some of their protection against heart disease and osteoporosis.
Unfortunately, the logic of non-bioidentical hormone replacement therapy (HRT) turned out to be fatally flawed for women. In 2002, the results of the Women’s Health Initiative were released early. This landmark study followed more than 16,000 women and assessed the effects of non-bioidentical hormone replacement therapy (HRT), including estrogen-only therapy and therapy that combined non-bioidentical estrogen and progestin. The findings were shocking: the estrogen/progestin arm of the study was terminated early because the non-bioidentical hormone therapy not only failed to protect against heart disease, but was shown to increase the risk of heart attack and breast cancer (1). These alarming findings led a team of researchers to boldly state in the prestigious Journal of the American Medical Association that “…the results indicate that this regimen [non-bioidenticalestrogen/progestin] should not be initiated or continued for primary prevention of coronary heart disease.”1
In 2004, the non-bioidentical estrogen-only arm of the study was terminated as well because hormone replacement therapy (HRT) with conjugated equine (horse-derived) estrogen was found to increase the risk of stroke.2 These findings had an immediate impact on the millions of women taking non-bioidentical HRT, of whom up to 50% discontinued their use of non-bioidentical HRT.3
1. JAMA. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial.2002 Jul 17;288(3):321-33.
2. JAMA. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial.2004 Apr 14;291(14):1701-12.
3. Ann Intern Med. A three-part intervention to change the use of hormone replacement therapy in response to new evidence. 2004 Jul 20;141(2):118-25.