Is HRT a medical breakthrough as it was first thought, or a dangerous health time bomb? This is a question that has been debated ever since it was first discovered. This had led to women today being more confused that ever before. Is it safe to take ? and what are the long-term implications of taking it?
The media reports on medical findings can be very confusing too -they have said on the one hand, that HRT is good for women?s health and on the other, that it causes breast cancer and other diseases. So what are you to believe? Hopefully this page will shed some light on the subject and guide you though some of the real facts about HRT.
In the first place, it must be said that doctors do not always take enough care as to what they prescribe. Their whole mind-set is being constantly on the alert for some ?magic bullet? that can alleviate the health problems that they are constantly bombarded with, and which threatens to overwhelm them nearly every day.
This desire to help the sick and alieviate ill-health makes them an easy target for the drug companies, and drug company salespeople can convince any doctor to take on board their therapies and pills. Every time there is a new health or medical ?breakthrough?, doctors are often willing to embrace it, and many are slow to consider whether it has the correct supporting evidence of the drugs effectiveness.
It is only AFTER all the health and safety data has finally come in ? often years after it has been prescribed for millions of people ? does the medical profession realize that once again it has been led down the wrong path.
HRT as a preventative?
The drug companies made a clever tactical move away from claims that their products can heal illness to claiming that drugs can prevent illness occurring in the first place. For nearly 30 years, the preventative of choice for the medical profession and the drug companies has been Hormone Replacement Therapy or HRT
In fact HRT has got such a health reputation of being a good thing to take to treat the ?disease? of female old age that it has been referred to more than once as ?the most important preventative medicine of the century?.
HRT was first discovered by a British chemist and promoted by an American Gynecologist named Robert Wilson, who did more than anyone to make HRT popular in the 1960s. Menopause was seen as an ?illness? and women were therefore naturally ?missing? a vital health hormone at a certain age.
By the 1990s, an estimated 14 million, or about a third of all post-menopausal women in the US were taking HRT. Oestrogen became the second most prescribed medicine in America and a top seller in Britain ? before a single truly scientific health study evaluated what taking unopposed oestrogen would do for women?s long-term health.
What happens during the Menopause?
The menopause is a decline in the production of the female hormones oestrogen and progesterone, which affects all systems in the body. The main function of these hormones is to regulate the monthly cycle, pregnancy and birth, and the beginning and end of the reproductive cycle.
As levels of Oestrogen diminish to a lower level (which the body will eventually adjust to) women can experience the familiar symptoms of the menopause: hot flushes, night sweats, vaginal dryness, thinning of the vagina and uterus and a lack of interest in sex.
These hormones also affect the density of the bones; after the menopause many women suffer from a thinning of the bones called osteoporosis (brittle bone disease), which can cause fractures of the spine or ?dowagers hump? of female old age.
Doctors have the theory that a lack of oestrogen is also behind the sharp rise in heart disease and ill-health in women over 50, as younger women still producing normal levels of the hormone do not suffer the same levels of heart disease.
What does HRT do?
HRT uses ?natural? oestrogens (in most cases from the urine of pregnant mares), and more recently artificial progesterone ? essentially the same two hormones used in the birth control pill (although in the Pill, both are synthetic). The idea is to trick the body into thinking it is still pre-menopausal, in order to postpone, reduce, or eliminate the symptoms of the menopause.
HRT is available in tablet form, a cream, an implant or a patch. When first developed in the 1960s, HRT was mainly prescribed for women with severe menopausal symptoms. Although truly scientific studies were never carried out, the first health reports from some studies threw up a few warning signs ? oestrogen taken on its own could cause endometrial (womb lining) cancer.
Drug companies responded with the highly speculative theory that they should add synthetic progesterone into the mix, pointing to health research showing that the same dangers would not exist if a combination was used. It was believed that by doing this, it would hold the effects of the oestrogen in check.
The Early Warning Signs
Despite this reasoning, a number of small health studies suggested that that there was a breast cancer risk with both types of HRT preparations. The only thing they didn?t know was how big a risk it actually was. Some studies showed a risk of 30 ? 60 percent and even 80 percent. Far from being protective, drugs containing synthetic progesterone more than quadrupled the health risk.
The landmark Nurses Health Study, produced by Harvard Medical School, found that for those using HRT for more than 5 years had a 46 percent chance of contracting breast cancer. For women over 60, the risk was up to 71 percent.
For uterine cancer, the research found that oestrogen alone increased the risk from 3 to 20 times, but adding progesterone could increase the risk of getting cancer to up to 80 percent over those NOT taking it.
As HRT is given to healthy women suffering symptoms during a normal bodily process, the life threatening risks of the drug far outweighed its small benefits. Developing cancer as a result of taking HRT was not really a fair trade-off for being rid of menopausal symptoms.
Risks Vs Benefits
To rebalance the risk versus health benefits, the drug companies came up with the idea that HRT could be pitched as an all-purpose cure-all of the bugbears of old age for ALL women, not just those who were suffering menopausal symptoms. Doctors began to speak of HRT as a preventative of all the major diseases of life after 50; heart disease, osteoporosis, stroke, and even Alzheimer?s.
The argument was that the risk of breast cancer from the drug was far less than the natural risk that post-menopausal women face of developing osteoporosis and heart disease. From the time of its launch, doctors began playing with health statistics, using loosely assembled studies to promote future protective health benefits.
In time, the ?benefits? became even more speculative. HRT was even tried out in treating women with inflammatory bowel disease. For many years doctors dismissed the cancer risks of HRT as unproven, mainly because the studies were small and researchers simply selected groups of women ? one group on HRT and the other not, and observed them over time to see which group was healthiest. This type of study is NOT scientific.
The line that was adopted was that, although HRT could increase breast cancer risk, that risk was small and besides, breast cancer is ?treatable?. Some consultants even said that studying the effects of HRT further was ?illogical?.
Results of Large Scale Studies
When the first large scale scientific health studies took place, this easy dismissal could no longer be sustained. The Women?s Health Initiative (WHI) was a major 15 year study set up by the National Institutes of Health in America to examine the common causes of death and illness in post-menopausal women.
This involved some 16,000 participants, half being randomly placed into either a group receiving a combination HRT drug and the other a placebo (a sugar pill). In addition, 10,000 women who had undergone a hysterectomy received oestrogen alone. The plan was for the experimental group to take the drug for 8 years and then see if it did have the protective health effects it had grown famous for.
After 5 years the Data and Safety Monitoring Board of the WHI called a shock halt to the health study. The figures were suddenly indisputable: women taking HRT were more likely than normal to get breast cancer. Not only that, but they were more likely to get many other diseases ? diseases that HRT was supposed to protect against, like heart disease, stroke, blood clots and dementia.
By the time that the British equivalent of this health study, called the Million Women Study had published its findings, the evidence was overwhelming. Women WERE in more danger of ill- health by taking HRT. It showed that after 5 years, 1 in 166 women may get cancer, after ten years, 1 in 50. No matter what type of HRT or what mode it was taken, cancer risk increased with every year of taking it.
More recently a Swedish health study was halted after just two years (the plan had been for 5 years) after negative results came in.
HRT Myths Revealed
What of the benefits of avoiding osteoporosis? Most health experts agree that women taking HRT show increased bone density. However, long term studies have shown that women following the usual recommendation to take the drug for 10 years from the start of menopause are not protected any more from osteoporosis that are those women who have never taken the drug at all.
It preserves bone mass ONLY when women are taking it ? and only then if it is taken for 7 years. As soon as women stop taking the drug, bone mineral density catches up by a rapid decline, so that aged 75 it is virtually the same as in women who have never taken it. This means that HRT offers no protection to those during the time of life when the risk of developing osteoporosis is the greatest.
To get around these problems doctors have variously recommended that HRT should be taken forever (where breast cancer risks keep mounting) or begin it 10 years after the menopause, long after a woman has experienced all the symptoms the drug is supposed to alleviate!
HRT Side Effects
At best, taking HRT seems to have only a temporary effect. Without all the claimed health benefits, all HRT offers is a list of potentially fatal side effects. Women taking HRT as a tablet have experienced gastro-intestinal problems, nausea, bloating, abdominal cramps, and even jaundice.
The skin patch, which bypasses the liver, results in higher amounts of oestrogen being absorbed by the body. However, a fifth of patients experience blisters, increased blood flow in the area, and discolouration of the skin using this method. An increasing number of women now use implants, which require a small outpatient operation to insert the pellets under the skin.
Oestrogen implants cause a ?tolerance? for oestrogen that some doctors warn is similar to addiction. A woman will have higher than normal levels of oestrogen in her bloodstream, but nevertheless complains of the return of menopausal symptoms at increasingly frequent intervals.
Although these implants are supposed to last for 6 months, many users complain of a return of symptoms just 3 to 9 weeks later. This occurs on average with 3 out of every 100 women, according to a recent study by the Dulwich Hospital Menopause Clinic in London.
HRT tends to lift mood and creates artificially high levels of oestrogen in the body. This could trigger a hormonal ?crash? when these levels fall even slightly, and so make menopausal symptoms come back with a vengeance. And if women have to stop taking HRT for any health reason, menopausal symptoms have been reported as coming back more severe than before
Without HRT, The body?s pituitary glands and ovaries work in tandem, constantly adjusting hormone levels to fit the body?s health need of the moment, like an automatic pump. A constant stream of oestrogen and/or progesterone with taking HRT upsets this delicate balance and causes all kinds of unpleasant ? and dangerous- symptoms. These are just some of the side effects that have been reported:
Urinary tract infections, migraines, depression, enlarged and tender breasts, high blood pressure, changes to the shape of the eyes, hepatitis, liver cancer, jaundice, excess fluid in the tissues, heart attacks, thrombosis, endometriosis, and an increase in facial hair, and deepening of the voice.
So called ?Natural? Alternatives
Now HRT has been largely discredited for health, many doctors are now turning to natural alternatives. One of the favourites at the moment is the so-called ?natural? progesterone, which is being sold as a cream and touted as the solution for being female and over the age of 40.
?Natural? progesterone is so called as it is derived from yams, but it is in fact made in a test-tube. Chemists make this as close to the natural molecular structure of the body as possible, but it still has to go through chemical processing, and all share similar side effects. This type of progesterone is called progestogen. The side effects of one of the most popular brands in the UK, Gestone include loss of vision, double vision, migraine, changes in the cervix or breast, and insomnia, to name just a few.
Progestogen is sold as a ?cosmetic? in the US and imported by the UK. As such, manufacturers don?t have to go through the safety testing needed by the FDA. And because there are no regulations in the US, any manufacturer can put in any amount of the hormone progestogens they wish.
One laboratory found creams ranging from 2mg per ounce to 700mg per ounce. This is worrying when you consider the minute doses needed by the body to keep things ticking over. With the rub on cream, women could be enhancing the concentration in the blood by 5 times normal levels.
Alternatives to HRT
If you decide that all the risks are not worth it, just to rid yourself of hot flushes, there are many healthy alternatives.
Many nutritional therapists argue that the kind of menopause you experience tends to reflect your health and nutritional state. In this way, a difficult menopause IS a deficiency disease, but not a deficiency of oestrogen.
The root of the problem is a deficiency in one of a number of vital nutrients, food intolerance, or the inefficient working of some organs. Most nutritional practitioners now recommend an unprocessed wholefood diet with first class proteins, and an individually tailored supplement program to help the body make its own oestrogen during the early stages of the menopause.
My Experience of the Menopause
I started the menopause when I was in my late forties. My diet was not good back then and I also smoked and drank more alcohol than was good for me. I too suffered from hot flushes and night sweats, but thankfully I never was tempted to take HRT, as I had read some reports about the bad side effects.
Despite this, I was still diagnosed with breast cancer in 2004 due to other factors, mainly, a poor diet, stress, grief, depression, and a low immunity. The menopause symptoms were much worse before I started on my healthy diet, so I know that good nutrition is a key factor in reducing the severity of the symptoms. I continue feeling well, and have night sweats on occasion, but have never experienced any other menopausal symptoms for over three years.
Preventing Osteoporosis
To prevent osteoporosis, the solution is far more complicated than drinking large amounts of milk or taking calcium pills, as most doctors now recommend. Researchers have discovered that osteoporosis is not caused by calcium deficiency and cannot be prevented by large doses of calcium. Instead its been found that magnesium deficiency plays a key role.
Regular weight bearing exercise has been shown to prevent osteoporosis, even in women past the menopause, despite the medical claim that if you don?t exercise before 40, you can?t do anything to improve your bones. Cigarette smoking accelerates the destruction of oestrogen and so brings on both the menopause and osteoporosis. By stopping smoking you can reduce your risk of hip fracture by 25 percent.
Another reason we in the West may be plagued with osteoporosis is our tendency to eat excessive amounts of protein. As calcium is needed to process protein in the body, a high-protein diet means calcium is constantly leeched from the bones. Osteoporosis is hardly ever known in places like Africa where they eat smaller amounts of protein and more whole foods.
Finally, ensure that you get your digestion checked as low levels of stomach acid can be responsible for low absorption of calcium. You may want to take a supplement of vitamin D, which increases the uptake of calcium in the diet, and small supplements of boron, which also aids in absorption.
Source: http://www.yupedia.com/health-and-hrt-hormone-replacement-therapy-what-are-the-real-risks.html
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