Monday, November 11, 2019

1. Estrogen causes cancer.

This is probably the most common myth I encounter when talking to women about hormone replacement. I could mention to someone that by taking hormones, you will lose weight, feel great with improved energy and better mood and have reduced risk of heart disease, hip fracture and dementia, which are the three most common causes of death in older women. Despite all these benefits, many women are apprehensive about starting hormone replacement because of this fear about cancer. Fortunately, estrogen does not cause increased risk of breast cancer and when appropriately balanced with progesterone, does not cause increased risk of uterine cancer. In the largest hormone study, the WHI study, the relative risk of breast cancer with Premarin (the pharmaceutical version of estrogen) alone was 1.0, which means that there was no increased risk of breast cancer with Premarin. Furthermore, bioidentical estradiol (the version of estrogen that I recommend), actually has slightly decreased risk of breast cancer. Women with higher amounts of visceral fat have increased risk for cancer and estradiol helps reduce visceral fat. In sum, estradiol does not cause increased risk for breast cancer!

2. Estradiol is dangerous for women who have clots, leading to possible heart attack or stroke.

Pharmaceutical Premarin is derived from horses, hence its name, which is a truncated version of pregnant mares’ urine. Premarin is a stronger type of estrogen, with 10 different subtypes of estrogen, several of which were not meant for humans. The consequence of this is that in several studies, it is demonstrated that when a woman has heart disease with clots formed in her blood vessels, there is a chance that Premarin can dislodge some of these clots, resulting in heart attacks and strokes. In the WHI study, this occurred in 30/10,000 women, or 0.3%. While this is not a high risk, it is still of concern.

However, multiple studies have not demonstrated that bioidentical estrogen causes such dislodging of clots. To the contrary, estradiol is very protective against heart disease. Studies have shown that women who take estradiol have a relative risk of 0.39 for getting heart disease, or in other words, 2.5 times less likely. There are two main explanations for the decreased cardiac risk with taking estradiol. For one, women lose an average of 10 to 15 pounds with bioidentical hormones and much of that loss is visceral fat. In my clinical experience, I have seen that women who are more overweight lose a lot more than that. Much of that weight loss is visceral fat, which generates clots and is the genesis of heart disease and cancer. With the loss of this visceral fat, the risk of heart disease is much decreased. Also, women who take bioidentical hormones lower their LDL cholesterol, which is pro-inflammatory, and raise their HDL cholesterol, which is the good cholesterol that reduces clots. This contrasts with statins, which reduce total cholesterol but also reduce HDL cholesterol. Thus, estradiol is very beneficial in protecting against heart disease.

3. Provera is the same as progesterone.

Provera is a synthetic pharmaceutical version of progesterone. Progesterone is a feel-good hormone that improves mood and improves sleep. Many women relate that they felt their best during pregnancy which is the time when progesterone levels are the highest. Also, progesterone is anti-proliferative, meaning that it protects against cancer. On the other hand, Provera has many of the opposite effects. Due to its similarity to progesterone, it blocks many of the receptors for progesterone. Thus, women who take Provera often complain of anxiety, irritability, depression and insomnia. In the WHI study, it was shown that Premarin had some cardiac benefits when taking it soon after menopause but Provera negated much of that cardiac benefit. However, bioidentical progesterone works synergistically with bioidentical estradiol for enhanced cardiac benefit. Also noted in the WHI study was that Provera, when taken with Premarin, increased the risk of breast cancer by 30% to 1.3. Progesterone on the other hand is protective. So Provera is not the same as bioidentical progesterone; they are closer to being opposite from one another.

4. Women don’t need testosterone. That’s for men.

Before menopause, women produce testosterone, which is a source of energy and vitality. Testosterone production stops at menopause. There are many benefits for women to achieve with replacing testosterone. Testosterone helps burn fat and build muscle. A common symptom of menopause is decreased libido. Testosterone is a key driver of libido for women and will enhance lubrication. A great benefit of testosterone is protection against breast cancer. Testosterone plays a key role enhancing energy and vitality with improved mood. Of course, a woman’s dose is much lower than a man’s. While men may start with a dose of 150 mg twice daily, women will usually start at 5mg once daily. That is often enough to reap testosterone’s great benefits.

5. Osteoporosis is an inevitable part of aging, especially for women.

The reason I have included this among the hormone myths is that by taking bioidentical estradiol, women can significantly reduce the risk of osteoporosis and hip fractures. There is dramatic bone loss at the time of menopause, which continues due to the loss of estrogen. The potentially fatal consequence of osteoporosis is a hip fracture, which has 19% risk of death for women within one year. To combat this, bisphosphonates such as Fosamax are prescribed. These slow the bone loss so reduce fracture risk but do not reverse osteoporosis. On the other hand, bioidentical estradiol actually promotes bone growth so bone density increases. Thus, estradiol not only decreases the progression of bone loss, but actually promotes bone growth so can reverse osteoporosis, which will obviously decrease fracture risk.

To summarize, bioidentical hormones have so many benefits for women including weight loss, increased energy and vitality, improved mood and better sexual health with increased libido and improved lubrication. Also, bioidentical hormones decrease the risk of the three most common causes of death in older women, heart disease, osteoporosis with hip fractures and dementia. I have reviewed some of the myths that make many women reluctant and apprehensive about taking advantage of these great benefits. Hopefully, women will understand that these are myths and will then reap these great benefits.

By Warren Slaten, M.D.

Dr. Slaten is a wellness physician specializing in regenerative pain treatments and lifestyle counseling. He is certified in advanced bioidentical hormone replacement. To learn more, check out his website at www.njhormones.com