Articles and Recordings

March 3, 2011

To HRT or Not to HRT
Thoughts on Hormone Replacement Therapy

We have seen a number of clients recently with hot flashes and other symptoms of perimenopause and menopause.  They have asked us about hormone replacement therapy (HRT) and other ways to deal with symptoms.  I've been reading recent books on the topic to find out what the experts think.

Of course, the experts don't agree with each other.  Each author I read had a slightly different--or radically different--message and recommendations. They've read the same studies but have come to different conclusions.  In which expert, then, does one put one's faith?

We recognize that there is no one-size-fits-all solution.  In our practice, we allow the client's body to tell and show us which options are the best fit for that individual. For information's sake, I'll share some of what I explored, but keep in mind that it always comes back to what each specific woman's body needs. 

The author of the first book I read, The Cleveland Clinic Guide to Menopause by Holly L. Thacker MD, is a major proponent of hormone replacement therapy.  Thacker wrote about the famous Women's Health Institute study, which scared many doctors and their patients into going completely off HRT.  That study was stopped midway in 2002 because  the researchers found such an increased risk of heart disease, strokes, breast cancer and blood clots in their subjects that they could no longer ethically continue the study.

Thacker wrote that many of the subjects were older women who were 10 or 25 years past menopause and the study was designed to see if taking hormones would protect their hearts and bones as they aged.  She speculates it was the age gap between going through menopause and reintroducing hormones to the body through HRT after a long absence that was dangerous for these women, and that if younger women had been studied, women on the threshold of or just through menopause, the results would have been more positive.  Thacker continues to prescribe HRT to her patients, believing that for most of them HRT is a healthy option and the only thing that will relieve the worst of menopausal symptoms.  A few women I know use this approach and it seems to work for them.

After Dr. Thacker's book I thought, so maybe it's okay for women to use HRT--until I started the next book, No-nonsense Guide to Menopause by Barbara Seaman and Laura Eldridge.  They offer a history of menopause and how it has been viewed by society and doctors over the years, emphasizing that menopause is a natural life process, not a disease that needs a drug to treat it.  They note that there have been no comprehensive studies on hormone use, except for the WHI study noted above.  With no definitive findings from double-blind studies, no options have been proven to be safe.  Everything a woman might try, including herbs, is on a trial and error basis, and may or may not increase the risk of breast cancer and heart disease.  Proceed at your own risk, they say. The information they present is interesting--but may leave you uncertain in charting a course for yourself.

One point about HRT:  Subjects in the WHI study were given estrogen made from the urine of pregnant mares, and synthetic progestins, and most doctors today still prescribe synthetic hormones.  Some believe that bio-identical hormones--those having the same chemical composition as the hormones the human body produces--are a healthier choice for the body. One study I read [
The Bioidentical Hormone Debate : Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy? by Kent Holtorf, MD] concludes that bio-identical hormones seem to reduce the risk of breast cancer, compared to synthetic hormones. 

Holistic doctors, and even your more traditional gynecologist, if you ask her or him, will write a prescription for you to try bio-identical estradiol (one of the three estrogens our bodies make) and progesterone.  Your doctor will likely tell you there is no difference between the bio-identical and synthetic hormones, but if you express your preference for bio-identical, they will usually write the prescription. These products are available through the
Women's International Pharmacy, and other compounding pharmacies. WIP will send you an information package if you email a request for it.

Other books (from the shelves of my local library) sounded much like the first two I read. Until I picked up Susun Weed's book,
NEW Menopausal Years, the Wise Woman Way Alternatives for Women 30- 90).  This book was more in line with my sensibilities.  Weed takes a holistic approach, encouraging us to move our bodies, eat a range of wholesome foods, and support our entire hormonal system. (She advocates going meatless. That's okay for some bodies, but other perimenopausal bodies thrive on animal protein.)  Rather than double-blind studies, she puts stock in herbal and wise woman traditions. For each menopausal symptom, Weed offers a six-level approach and encourages readers to start with simple, benign options, and not to pull out the bigger guns unless needed.

Weed's approach looks like this:

Step 0 is to do nothing, (What a concept!) to unplug, sleep and rest.

Step 1 is to collect information (go to the library, Google, support groups, etc.).

Step 2 is Engage the energy though ritual, prayer, visualizations, etc.

Step 3 is Nourish and tonify though lifestyle changes, physical activity and mild herbs.

Step 4 is Stimulate/Sedate using herbs, acupuncture, massage, etc. 

Step 5a is Use supplements, such as vitamins or minerals like calcium.

Step 5b is Use drugs, such as hormones. 

Step 6 she calls Break and Enter and includes surgery, Rolfing, psychoactive drugs, etc.  
For each symptom--such as hot flashes, sleep disruption, fatigue-- Weed offers a long list of things to try in each of the levels. The book is an excellent resource and lends itself to muscle-testing the herbs or activities that might be most supportive for your individual body. 
Bottom line, there is no one right way for all women going through these changes, each person may have different needs.  For most women, it's a trial and error process to see what fits for you.  Some women are able to find a level of comfort without ever using HRT; some do better with it.

But if your body is telling you what it wants and which approach addresses its specific needs, the choices become much clearer.  If you or someone you know is navigating this territory--menopause or perimenopause--Steve and I are happy to offer our support in considering your options, using muscle-testing to help you to find the solutions and support that are right for you.  In this way your body can have exactly what it needs.

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