Posts Tagged "HRT"

Bioidentical hormones for menopause: what’s the latest?

Posted by Liz on Mar 19, 2012 in bioidentical hormones | 2 comments

It’s been some time since I covered the topic of bioidentical hormones. And with the lastest review of the Women’s Health Initiative data and yet another push in favour of hormone replacement therapy (HRT), I thought that an update was in order, particularly because the naysayers continue to emphasize that HRT is the end all to be all and that there are not evidence-based alternatives.

Think again.

For those of you who need a refresher in bioidenticals, they are hormones that are molecularly similar to those produced naturally by the body. HRT is manufactured and consequently, has been shown to alter how cell receptor bind to these hormones and function. Bioidentical hormones are often compounded in specialized pharmacies, i.e., they are individualized as directed by a health professional to the exact dosage and regimen required,  based on a woman’s personal symptoms, hormone levels, and preference. Yet, claims that they are safer and equally effective alternatives have been challenged, namely due to the lack of scientifically sound data.

At last, that challenge is beginning to change, as more and more women turn away from HRT. In a recent study published in the open access journal  BMC Women’s Health, researchers observed 296 menopausal women receiving compounded bioidenticals from six community pharmacies over a period of 7 years.The majority of women in the study were an average of 52 years old, in good health, and of moderate to average rate; most had not used HRT before. Although various compounded forms of bioidenticals were used in the study, the majority were topical, followed by oral, vaginal and under the tongue (sublingual). Moreover, all women were started at low doses of either progesterone as a single therapy or in combination with estrogen and then adjusted accordingly.

Overall and within three to six months after starting therapy, women reported significant improvements in their mood, including at least a 25% reduction in mood swings, irritability and anxiety. They also reported improvements in night sweats and hot flashes. Moreover, women who started on progesterone only therapy had much greater reductions in their mood symptoms compared to women who started on combination therapy.

Bioidentical hormone therapy also proved to be safe, with no woman experiencing a heart attack or developing breast cancer, although importantly, longer follow up times are needed before safety can be firmly established.

So, what are the drawbacks here? First, this was an observational study and undoubtedly, by relying on women to self report symptoms, there’s always room for bias. Still, this is the first well designed trial looking at compounded bioidentical hormones as opposed to manufactured formulations. And, while significant improvements were seen in mood symptoms, the verdict is still out with regards to vasomotor symptoms, i.e. night sweats and hot flashes.

Like any therapy, hormone or alternative, speak to a health practitioner first. Make choices based on information, not simply advice. Right now? Compounded bioidentical hormones appear to offer an advantage over HRT but more study is needed. Clearly, they may not offer the same benefits in terms of flashes but again, more research is needed.

I like the fact that scientists are starting to pay attention. You?

Wednesday Bubble: is DHEA the path towards a better sex life?

Posted by Liz on Dec 21, 2011 in estrogen, HRT, sexual desire, sexual health | 2 comments

Today’s Bubble is a doozie that can one of two ways: in the yes(!) column or in the no (!) column. I’ll leave it to you to decide.

DHEA is the most abundant sex hormone in circulation and is mostly secreted by the adrenal glands. Research has shown that low DHEA levels in pre- and postmenopausal women may negatively affect sexual functioning, while ample blood levels may enhance sexual functioning, cognitive functioning and wellbeing. Yet, whether or not DHEA really works continues to be controversial. And the reason behind the burgeoning interest is the quest to find a suitable replacement for HRT. The thing is? There are lots of suitable, evidence-based replacements that are not broadly accepted by many medical professionals and many of these are discussed regularly on this blog. Nevertheless, here’s what researchers have just discovered about DHEA.

The researchers, from Pisa, Italy, followed 48 healthy, postmenopausal women for a year. During this time, they divided 36 women who were experiencing troublesome menopausal symptoms and requesting hormone replacement into three groups:

• 12 women who received 10 mg daily of DHEA
• 12 women who were given combined HRT
• 12 women who received the synthetic hormone, tibolone, daily

The fourth group was comprised of 12 women who did not wish to use HRT. They received daily vitamin D (400 IU) and calcium to help combat osteoporosis.

At the start of the study, all of the women reported similar sexual activity. However, after a year of treatment, women taking DHEA had significant increases in sexual interest and activity scoring almost 14 points higher on a questionnaire used to measure sexual interest, satisfaction, vaginal lubrication, orgasm and sexual partner. The women taking HRT experienced similar benefits, and women in both of these groups reported engaging in more sexual intercourse compared to women taking Vitamin D and calcium. Women taking the synthetic hormone also had increased sexual interest scores but they were not as high as the other two hormone groups. The magnitude of improvements in menopausal symptoms was also similar between the DHEA, HRT and tibolone groups.

The reason for this improvement appears to be the effect that DHEA has in terms of improving blood levels of the hormones estradiol and progesterone, both of which decline during menopause. It also appears to positively affect adrenal functioning.

What to think? Well, the study didn’t include any information on side effects. This is what Mayo Clinic has to say in that regard:

“No studies on the long-term effects of DHEA have been conducted. DHEA can cause higher than normal levels of androgens and estrogens in the body, and theoretically may increase the risk of prostate, breast, ovarian, and other hormone-sensitive cancers. Therefore, it is not recommended for regular use without supervision by a licensed health professional.”

Another important fact, acknowledged by the researchers, is that DHEA was only studied in 12 women, hardly enough to draw any firm conclusions. But they do believe that the findings, albeit preliminary, are encouraging, especially for women who “may have problems in taking more conventional HRT.”

Personally, I believe that it’s waaaaay too early to even consider DHEA as an alternative to HRT and in particular, to androgen therapy for sexual health. I want to see more information on side effects before it’s even on the radar. Meanwhile, I would love to hear what you think:

Yes!?

or,

No!?

Wednesday Bubble: More on breast tenderness, hormone replacement and breast cancer

Posted by Liz on Nov 30, 2011 in breast cancer, HRT, menopause | 2 comments

More bad news on the hormone replacement front: if you are taking estrogen (conjugated equine estrogen) with progestin (medoxyprogesterone) for menopausal symptoms and experience breast tenderness, you may want to think twice.

Frankly, this news isn’t exactly new. Because back in 2009, UCLA researchers reported similar findings in the Archives of Internal Medicine. These newer data, provided by the same researchers at UCLA’s Jonsson Comprehensive Cancer Center and published online in Breast Cancer Research and Treatment only add to the hormone risk fodder.

The researchers say that in their research, they’ve consistently run across data that suggest that “estrogen plus progestin compared to estrogen alone, have a more marked effect on breast tissue,” possibly due to more growth, leading to greater density. According to the lead study author, Dr. Carolyn Crandall “higher breast density (has been shown to be) associated with a higher risk of breast cancer,” adding that “in women with extremely dense breasts, the cancer risk can be four to six times higher than for women whose breasts are not dense.”

In this update, Dr. Crandall and her colleagues reviewed data from the Women’s Health Initiative, specifically focusing on reports of new breast tenderness. At the study’s start, almost 12% of women taking estrogen alone or estrogen in combination with progestin reported having breast tenderness. However, by the first year, women in the combination hormone therapy group reporting onset of breast tenderness after starting hormones had a 33% greater risk of developing invasive breast cancer compared with their peers who did not have breast tenderness. And while estrogen alone also increased the risk for developing breast tenderness, the effect was less than that of the combined hormones, especially since it did not lead to an increased breast cancer risk.

So, what to make of these new data? If you are taking HRT and develop breast tenderness, you need to speak to your health practitioner, assess your risks and make a joint decision as to whether or not the benefit of fewer menopausal symptoms is worth the risk of possibly developing an invasive form of breast cancer. And if you are not yet using hormone therapy, you may just want to step back and think twice.

Buyer beware: hormone therapy is a slippery slope with bumps, bruises and perhaps serious disease. Is it worth it? Only you can decide.

Breathe. What you need to know about asthma and HRT

Posted by Liz on Sep 30, 2011 in asthma, HRT, menopause | 0 comments

If you suffer from asthma, you will want to take note: researchers presenting at this week’s European Respiratory Society AnnualConference have shown that female asthmatics have an increased risk of landing in the hospital if they take hormone replacement therapy (HRT). Yet another nail in the HRT coffin, once again demonstrating that the health risks of taking hormone replacement may outweigh the benefits.

Notably, studies have shown that asthma risk increases in women after puberty. Moreover, hormones, most specifically fluctuating estrogen levels, can impact airways as much as allergies and hay fever (fluctuating estrogen levels can produce an inflammatory response and exacerbate breathing difficulties). On average, asthma symptoms develop in about 21% of menopausal women and more than twice as many using hormone therapy.

In this study of over 23,000 Danish women with documented asthma, researchers looked specifically at hospitalizations for severe reactions. They also collected information on smoking, exposure to smoke, body mass index, level of physical activity, history of hysterectomy and use of HRT.  The findings? Using HRT increased the risk for hospitalization for severe asthma reactions by as much as 40% compared to not using hormone therapy. What’s more, the longer the women used HRT, the higher their risk of ending up in the hospital; for example, if they used it for less than 3 years, they have a 29% increased risk and if they used it for more than 10, a 51% increased risk. Even more troubling was the fact that women didn’t smoke appeared to have the highest risk for being hospitalized in association with their HRT use.

Although this isn’t a randomized trial, and more information is needed, the researchers still recommend that practitioners be made aware of these findings. They say that the relationship between asthma and female sex hormones is hardly new, but that their findings confirm the relationship and further our understanding of it by showing the extent of severe asthma reactions that occur when women take hormones. “If a patient develops asthma or has a severe worsening of symptoms after taking HRT, they may need to stop hormone therapy altogether,” they add.

Newsflash: International Menopause Society has issued updated guidelines on HRT

Posted by Liz on Jun 10, 2011 in HRT | 7 comments

Got news?

I sure do!

The International Menopause Society has issued updated recommendations on the use of hormone replacement therapy (HRT, a term that they use to refer to estrogen, progesterone, combined therapies, androgens and tibolone). They note that the current guidelines are similar to those issued in 2007 but “include additional clinical data where needed.” And while they claim that there are “no reasons to place mandatory limitations on how long HRT is used (which by the way, runs counter to current recommendations of several major national and international medical associations), they do emphasize that HRT “should not be recommended without a clear indication for use, i.e. significant symptoms or physical effects of estrogen deficiency.”

The following are some highlights of the updated report:

• HRT should be used at the lowest effective dose to effectively reduce symptoms and maintain life quality
• Women who enter early menopause either spontaneously or due to hysterectomy or other condition before age 45 and particularly before age 40 may be at increased risk for heart disease, osteoporosis, mental disorders or dementia. Notably, the evidence of reduction of this risk via HRT is limited but is nevertheless recommended to preserve bone and reduce symptoms, at least until they enter the average age for menopause (i.e. ~52)
• Progestogen should be added to estrogen in all women with an intact uterus to prevent endometrial malignancies and cancer (except for in the case of low-dose estrogen)
• HRT is recommended to preserve bone health although it should not be started after age 60 and loses its effectiveness once therapy is stopped.
• Despite the controversy as to whether or not HRT is heart protective, the IMS says that it has the potential to boost or improve one’s risk profile because of how it affects the vascular system, metabolism of blood sugar, blood pressure and cholesterol levels. However, this recommendation is also framed within the recommendation that women adopt major primary prevention measures, such as stopping smoking, regular exercise, weight control, blood pressure reduction, and control of diabetes and blood pressure.

So, what about the risks of HRT that I’ve long written about on this blog? The convened panel disputes the conclusion of the Women’s Health Initiative (due to average older age of participants and when they started HRT) as well as data that have come down the pike since 2002. In fact, they say that the link with breast cancer is controversial and that HRT doesn’t initiate cancer (but rather, promotes an existing tumour). They also concur that data are still lacking with regards to type of HRT, doses, and administration type and incidence of breast cancer. And, with regards to endometrial cancer or stroke? They write that women with a uterus should be certain to add a progesterone component to their hormones to counteract any undue stimulation of their endometrium, and that stroke risk is related to increasing age and obesity, noting that risks may be avoided by using an estrogen patch or stopping use of hormones after the age of 60.

In general, the conclusion of the panel is than “most menopausal women have little to fear from the adverse effects of HRT” and that the benefits of hormone therapy outweigh the risks. Still, they do suggest that the decision to take HRT should be discussed with a physician and reviewed annually.

Not surprisingly, alternative therapies are completely
discounted in the IMS guidelines and they do not support the use of any bioidentical hormones whatsoever. Moreover, they make a point to place blame on the media without providing clear examples of their claims for “superficial and uncritical evaluations” of HRT, as if all media were one and the same.

I am not quite sure what to make of these recommendations. On one hand, they claim to have reviewed all the data since WHI but this panel convened four years ago. And while they are sure to promote HRT within a cautious framework, menopause continues to be positioned as a disease requiring treatment.Indeed, one of the report authors, Dr. Roger Lobos (Columbia University, New York), says that “the bottom line is that most doctors nowadays should feel comfortable about prescribing HRT to most women going through the menopause [but] like most medicines, you need to look at individual circumstances before deciding to taken it.”

Notably, media are once again positioned as the big bad wolf that misconstrue findings and attack  pharmaceutical companies for their profit motivations.

Has anything really changed except the date of the report? Well, the good news is that the IMS acknowledges that there are risks associated with HRT, at least for some women. And yet, the report still appears lack objectivity.

Do yourself a favour. Speak to your practitioner. HRT will shut down your symptoms. Period. But you must ask yourself, at what cost? Do your research. Ask the hard questions. And then ask them again.

You may be sweating. But the issue is greater than the sum of all sweats.