Dec 1, 2002

This page, as well as several other hormone-oriented ones on this site, is to some extent outdated, attitudes to Menopausal Hormone Therapy (in itself a significant change of name - note the abandonment of the term "Replacement") having undergone a major shift over the last few months. However, the page remains here as a record of earlier attitudes, as well as evidence against repeated claims that the WHI (E and P arm) results were a  "bombshell" and "unexpected." For more detail see the WHI page

By now, most major medical organizations have reviewed their recommendations about combination menopausal hormonal therapy and there is little to differentiate them. In general they say:

While treatment for hot flashes and other perimenopausal symptoms remains an option, a woman should be carefully counselled about the risks involved and an individual assessment made of her personal situation. Caution should be exercised about prolonged use.

Routine use of such therapy for the prevention of chronic postmenopausal conditions is not recommended;

Its use for both primary and secondary prevention of cardivascular diseas is contraindicated i.e. it should definitely not be used either both or after the development of such conditions.

Its use only for the prevention of osteoporosis should be carefully weighed against its risks, and alternative therapies such as bisphosphonates considered.

 

Until (if ever) there is evidence to the contrary, the assumption must be made that other formulations and dosages of estrogen and progestin carry the same risks as the specific ones in the study.

There is insufficient evidence as yet to decide for or against the use of unopposed estrogen as a preventive measure.

There is insufficient evidence as to whether or not phytoestrogens are protective against osteoporosis or cardiovascular disease. Many of them also list the  various herbs and supplements which are used for perimenopausal symptoms, while failing to point out that there is little or no evidence that they 'work'.

"NATURAL" vs "SYNTHETIC" HORMONES A Question of Semantics
The confusion that exists concerning "natural" versus "synthetic" hormones is largely a question of semantics. The function of hormones is determined largely by their specific molecular configuration, just as specific keys work only in specific locks. In hormone literature, a "native" or "natural" hormone is one which is identical in all respects to the hormone molecule as made by the animal in question. 

The word "estrogen" does not refer to any specific estrogen but is instead a class name for a group of steroids with some sort of estrogen effect. 

Progesterone, on the other hand, is not a class name but is the name of one specific hormone molecule, technically known as pregn-4-ene-3,20 dione, and is made in humans in their ovaries, testes, and adrenal cortex from pregnenolone which we synthesize from cholesterol. 

Let us allow that "synthetic" means man-made, i.e., in a chemical laboratory, and "foreign" means not native to human metabolism. Thus, progestins are synthetic foreign analogs of progesterone but having some activity similar to that of progesterone. 

Plant compounds that have some hormone effect in humans are termed "phytohormones." 
They are generally less potent that natural human hormones. 

Petrochemical compounds with some hormone effect are termed "xenohormones." 
They are generally much more potent and more toxic than natural human hormones. 

Medroxyprogesterone acetate is not progesterone; it is a progestin, a synthetic foreign analog of progesterone. 

Progesterone made chemically from diosgenin is progesterone, identical to that produced by the body and, therefore, can be termed natural. 

Estradiol, no matter how or who makes it, is a natural estrogen. Ethylene estradiol is not a natural estrogen; it is a synthetic foreign analog of estradiol, and is more toxic. 

Estrone, even from horses, is a natural estrogen. Equol, another estrogen from horses, is natural to horses but not to humans. 

Methyl testosterone is not testosterone. It is a chemical analog of testosterone and is more toxic than testosterone.

Prednisone or methylprednisolone are not cortisol or hydrocortisone. They are synthetic analogs of cortisone and are more toxic than the natural corticosteroids. 

All substances, organic or inorganic, are chemicals. Air is a mixture of gaseous chemicals.

The word "progesterone" is often used to refer to both synthetic and natural progesterones, although there are important differences. Synthetic progesterone is much more potent than natural progesterone -- up to 2000 times more potent in some cases, according to Neils S. Lauersen, MD (PMS: Premenstrual Syndrome and You, NY: Simon & Schuster, 1983). If given during pregnancy, synthetic progesterones have male-hormone-like effects on the fetus. But both natural and synthetic progesterones can enhance hormonal balance or suppress reproduction, depending on the size and timing of the dose. The correct name for synthetic progesterones is progestins or progestagens (sometimes spelled progestogens) and they are important constituents of oral contraceptives, either in combination with estrogen or on their own. Natural progesterone -- chemically identical to that produced naturally in the human body -- is derived from the wild Mexican yam (barbasco plant). Natural progesterones were isolated by Russell Marker, of Pennsylvania State College, in the 1930s. While experimenting with a type of plant steroid, called sapogenins, Marker realized that progesterone could be derived from one sapogenin, disogenin, found in this plant. 

 Schering Canada acquired distribution rights to this product and it is approved and on the market in Canada, under a new name, Prometrium®. Schering-Plough International, of Kenilworth, NJ, may monitor the success of this product before applying for approval to the FDA. [N.B. Now also approved and available in US]

My question is for the women who chose to do HRT.  Have you done any research on NHRT, if not and still use HRT, have unpleasant side effects, why?  If you have done research, what makes you opposed to NHRT? 

My research has failed to come up with any studies to speak of, so it isn't the case of being actively opposed so much as being totally in the dark about "N"HRTas opposed to rather in the dark about HRT's long term effects. Estradiol (the estrogen in the patch) was shown in a Swedish study (Shelly can probably cite which one) to have a higher risk for breast cancer than did conjugated estrogens. As a past user of both, I can say that in my case, estradiol was clearly more potent so that makes intuitive sense to me. Unfortunately, basically all long term research has been done using Premarin and Provera, *kindly* donated by W- A so even though much of the research was methodologically flawed, any evidence of the effects of hormone use is based on these two products. Even worse (in my view) is the use of Prempro in the WHI study the results of which are so eagerly awaited . Not only is no progesterone being used, but neither is there any testing of a cyclical method. It seems to me that W- A are making a very big gamble here - either they lose everything if the results are negative, or they gain a virtual monopoly as the makers of the only product to be tested as safe and efficacious. 

I'm just trying to understand why so many women won't try NHRT.

Natural Hormone Replacement: For women over 45 
     Wright, Jonathan V. & John Morgenthaler 
     Petaluma, CA: Smart Publications 1997 (paperback) 
     128pp.; index; resources; appendix; afterword 

     Dr. Wright is medical director of the Tahoma Clinic in Kent, Washington, and a well-known advocate  of the beneficial effects of estriol -- the least powerful form of estrogen. As an advocate of "natural hormones," i.e., hormones that are chemically identical to those produced in the human body, I expected that he would recommend use of hormones only when required. But Dr. Wright is apparently not immune to the massive and pervasive marketing efforts of the pharmaceutical companies. Again, women's aging bodies are defined as hormone deficient. The difference is that, in the authors' view, menopausal women need natural hormones -- estradiol, estrone, estriol,  progesterone, testosterone and DHEA. The arguments are familiar but sometimes carried to an extreme. For instance, research suggests that estrogen users may be able to delay the onset of  Alzheimer's (one form of senile dementia). Dr. Wright uses this to scare women into believing that estrogen supplementation can prevent senility (see pp . 13, 19, 99-100).