Lorraine Maita, MD
Hormone Replacement Therapy: Safe Solutions for Healthy Aging
Many women fear the onset of menopause. They find the changes in their minds and bodies to be
depressing. Most women gain weight and lose bone, hair, and memory, and their risk for cardiovascular disease increases. They suffer from hot flashes, night sweats, sleep disruption, mood swings, irritability, dry and sagging skin, loss of interest in life, low libido, anxiety, and depression.
The landmark 2002 study Women’s Health Initiative (WHI) initially scared many doctors from prescribing hormone replacement therapy, and women feared taking it. After years of researching the subgroups in this study and analyzing new trials of bioidentical hormone replacement therapy, there is new evidence that hormone replacement therapy can be beneficial.
Menopause Could Speed Up Aging
A research study found that cellular aging increases by an average of 6% in menopause. This seemingly small amount can add up over a lifetime.1,2Sleep disruption can age women faster. Postmenopausal women with five insomnia symptoms were, in another study, almost two years older biologically than women the same chronological age with no insomnia symptoms.”3,4
Doubts About Conclusions from the Women’s Health Initiative
The Women’s Health Initiative (WHI) emphasized the risks of hormone replacement therapy. One of the principal investigators in the study describes how the findings were misinterpreted. He discusses that there was no statistically significant harm for either breast cancer or heart attacks for women who began replacement therapy before age 60; therefore, women who abandoned hormone replacement therapy suffered needlessly. They were denied the benefits of relief from hot flashes, night sweats, sleepless nights, dry vagina, and painful intercourse, as well as the decreased risk of bone loss and cardiovascular disease.5Even long-term use may be safesince other studies did not show an increased overall mortality in an 18-year follow-up of postmenopausal women who received conjugated equine estrogens with medroxyprogesterone acetate for an average of 5.6 years, or conjugated equine estrogens for an average of 7.2 years.6
Problems with the WHI Study
Part of the challenge with the WHI study has been that it only showed increased risk in cases in which estrogens were combined with progestins but the use of unopposed estrogen was not linked to an increased risk of breast cancer. As compared with the WHI hormone formulations, the use of bioidentical estrogen and progesterone was associated with much better protection against breast cancer. The equine estrogens and synthetic progestins used in the WHI study are different in their chemical structures from the natural hormones that are produced in a woman’s body.7 Many studies have revealed that synthetic progestins and bioidentical progesterone have very different effects on tissues; while synthetic progestins may increase estrogen-stimulated breast cell proliferation, progesterone inhibits this activity.8
Also, while progesterone has anti-estrogenic activity in breast tissue, synthetic progestins bind estrogen receptors in breast tissue and show estrogenic properties.8 Finally, synthetic progestins convert weaker estrogens into more potent estrogens, while progesterone has the opposite effect.8 Moreover, transdermal (through the skin) estradiol, a route that avoids the ”first-pass” effect, was as effective as oral formulations, but it was associated with a better safety profile.9 The adverse effects of the synthetic progestin medroxyprogesterone acetate, including its increased risk for breast cancer, stroke, and cognitive dysfunction, have been documented in several studies.10
Further Evidence of the Benefits of Bioidentical Hormone Replacement Therapy
A 2009 Postgraduate Medicine review analyzed whether or not bioidentical hormones are safer or more efficacious than commonly used synthetic versions. Based on physiological data and clinical outcomes, the study concluded that bioidentical hormones are associated with lower risks of breast cancer and cardiovascular disease, and are more efficacious than their synthetic or animal-derived counterparts.8Many other subsequent studies support these findings.8,11,12,13,14,15,16
The Route of Administration of Hormone Therapy Affects the Risk
Studies in Climacteric found that giving estrogen transdermally decreases the risk of clots, embolisms, strokes, and gallbladder disease. Bioidentical progesterone had positive effects on decreasing blood pressure, clots, and embolisms and even breast cancer – contrary to the synthetic form medroxyprogesterone acetate (MPA). 11 The authors concluded that transdermal estrogen and oral progesterone are better hormone replacement options.12
Estrogen Has Many Health Benefits
The health benefits of hormone replacement therapy are many. Studies showed the benefits of estrogen on memory and executive function.17,18,19While the greatest benefits occur at a younger age, even women over 65 had improvements.20,21Bioidentical hormone replacement was also more effective than placebo in preventing depression.13 Coronary artery calcium scores were lower in the group taking hormones andhormone therapy, and mortality rates and the incidence of cardiovascular diseases were reduced.22One proposed mechanism by which estrogen decreases the risk of cardiovascular disease may be by controlling the outflow of sympathetic and parasympathetic activity.23
Reanalysis of data from clinical trials using age stratification found decreased coronary disease and all-cause mortality in women aged 50-59, without the risk of breast cancer. More risks of some complications, such as osteoporotic fractures, were seen in women who abruptly stopped HRT.14 HRT also significantly decreases the incidence of various symptoms of menopause and the risk of osteoporotic fractures −and it improves quality of life. In younger healthy women (aged 50-60 years), several meta-analyses now consistently show reductions in coronary heart disease (CHD). In addition, the reanalysis of data from the WHI, and additional studies conducted since then, confirm that there is a decrease in cardiovascular diseases and mortality when HRT is initiated soon after menopause.15 The International Menopause Society published its governing principles based on a review of the literature from 2013 onward. In general, they supported individualized treatment, as it is effective for vasomotor symptoms, urogenital atrophy, and improved quality of life.24
It is time to take the fear out of using hormone replacement therapy and to take a look beyond the myths propagated by the flawed conclusions in the Women’s Health Initiative. Subsequent studies have shown a multitude of benefits and less risk when hormones are given to the appropriate population.
About: Lorraine Maita, MD
Lorraine is a recognized and award-winning holistic, functional, and anti-aging physician and author. She transforms people’s lives by getting to the root cause of illness using the best of science and nature. Her approach is personalized— you are treated as the unique individual you are. Her areas of expertise include: bioidentical hormone therapy, weight loss, treating chronic illness, and executive health. Dr. Maita served as Chief Medical Officer and Medical Director for three Fortune 100 companies and is an Advisory Team Member for WOR radio, the #1 news/talk radio station in the New York metropolitan area. She has a private practice in New Jersey, and her website is www.howtoliveyounger.com. She is the author of Vibrance for Life: How to Live Younger and Healthier.
- Levine, M et al. 2016 July 25, (113) no. 33 9327–9332 in the PNAS http://www.pnas.org/content/113/33/9327.long
- Carroll, et al. Biological Psychiatry 2016, July 25
- Langer, R et al. Climacteric. 2017 Apr;20(2):91-96.
- Manson, J et al. JAMA. 2017;318(10):927-938
- Mueck AO Climacteric. 2012 Apr;15 Suppl 1:11-7.
- Holtorf, K. Postgrad Med. 2009 Jan;121(1):73-85
- Samaras N. Clin Interv Aging. 2014 Jul 23;9:1175-86.
- Stanczyk FZ et al. J Steroid Biochem Mol Biol. 2015 Sep;153:151-9.
- L’Hermite M Climacteric. 2013 Aug;16 Suppl 1:44-53.
- Simon, JA Climacteric. 2012 Apr;15 Suppl 1:3-10
- Gordon, JL JAMA Psychiatry. 2018 Jan 10
- Lobo, RA et al. Atherosclerosis. 2016 Nov;254:282-290.
- Lobo, RA Nat Rev Endocrinol. 2017 Apr;13(4):220-231.
- L’Hermite M Maturitas. 2008 Jul-Aug;60(3-4):185-201.
- Baskaran C. et al. J Clin Psychiatry. 2017 May;78(5):e490-e497
- Maki, PM Maturitas. 2015 Nov;82(3):288-90
- Maki, PM et al. Hum Reprod Update. 2009 Nov-Dec;15(6):667-81
- Gass, ML Menopause. 2015 Jul;22(7):685-6
- Duka, T et al. Psychopharmacology (Berl). 2000 Apr;149(2):129-39.
- Arnson Y, Abstract 1176M-05 presented at 66th Annual Scientific Session & Expo of the American College of Cardiology in Washington, DC.
- Lagranha, C. et al. Life Sci. 2018 Jan 1;192:190-198
- Baber, RJ et al. Climacteric. 2016 Apr;19(2):109-50.