Hormone Replacement Therapy – Part II
It is generally agreed by many physicians that the primary reason for Hormone Replacement Therapy (HRT) is symptom relief from menopause, with less emphasis on using hormone therapy for disease prevention. It is important that the woman know all risks and benefits associated with HRT and reminded that the risk for breast cancer does increase naturally for all women as they age, as does the risk of heart disease and osteoporosis.” “Women with a uterus who are currently taking estrogen plus progestin should have a serious talk with their doctors to see if they should continue it. If they are taking this hormone combination for short-term relief of symptoms, it may be reasonable to continue, since the benefits are likely to outweigh the risks. Longer term use or use for disease prevention must be re-evaluated, given the multiple adverse effects noted in Women’s Health Initiative (WHI).”
One physician associated with the WHI says, “always cautions patients about the potential for increased breast cancer risks.” First, she rules out women who are not candidates for HRT – those with bleeding problems of an unknown cause, suspected breast cancer or history of breast cancer, history of endometrial cancer or certain cancers of the uterus, chronic liver disease such as cirrhosis or a history of blood clots.
She further tells her patients who want to stop HRT that they can certainly quit anytime. First of all, with menopause, we’re not treating a disease, and stopping HRT has no major consequences, except perhaps a return of the original menopausal symptoms.
For both women who want to stop taking HRT and for women who choose not to start HRT, there are alternative therapies. For almost everyone, there are other treatment options. For instance, women they can reduce their risk of heart disease by stopping smoking and by keeping their weight, cholesterol levels and blood pressure under control. Prozac and some other antidepressants can relieve hot flashes. Prescription drugs such as Fosamax help protect against osteoporosis. Also, the drug Evista (raloxiphene HCI), prevents osteoporosis and further claims to lower total cholesterol and prevent breast cancer. However, because women on Evista may experience more hot flashes, it raises questions about how that might affect the brain. Research now suggests a link between hot flashes and Alzheimer’s. Evista belongs to a class of drugs called SERMs, or Selective Estrogen Receptor Modulators. A SERM being used in Europe Tibolone, may be more effective without the side effects found in Evista.
As women have become more doubtful about HRT, many are investigating herbal remedies. However, just because a product is derived from plants doesn’t necessarily mean it’s 100% safe or without side effects. Some herbal remedies work to various levels, but some actually don’t work; many have potentially dangerous side effects, especially when used at the same time as a prescription drug or in the presence of another health condition. There is even less data on herbal remedies (which are not regulated by the government) than there is on HRT.”
A popular herbal remedy is Black Cohosh, which seems safe for most women. Soy is another favorite, however it is not the panacea women would like to think it is, say noted physicians. To get any relief from hot flashes, you’d have to consume a high quantity (about 40 grams per day), and that raises serious calorie intake issues. Soy has gained popularity in the United States because it’s such a staple in the Japanese diet, where women generally have lower rates of breast cancer and menopausal symptoms. However, Asian women seem to be at a higher risk for osteoporosis. Other widely used remedies for relief of menopausal symptoms are St. John’s Wort and wild yam. With St. John’s Wort, women typically take three tablets a day for two to three months before finding relief. Yams contain a protein or protein-like substance that is similar to the progesterone hormone. But studies show that by itself it can’t have a hormone-like effect because the body lacks an essential enzyme necessary to unlock potential beneficial attributes. Some natural creams, especially those delivered transdermally and containing natural progesterone, are actually very effective in mitigating the symptoms of menopause. Natural progesterone with black cohosh is particularly effective.
Although these early findings from the WHI raise some cautions and pose some questions requiring further investigation, the most important thing about what we know is that women need to understand the risks and benefits so they can make informed choices – talk to your health care provider for further information.
Hormone Replacement Therapy Part 1
Hormone Replacement Therapy Part 2
Hormone Stress
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