Healthy Bytes

Hormone therapy and breast cancer

read time: 654 words, about 3 minutes

The National Institute of Health started the Women’s Health Initiative back in 1991.
This is a huge 15 year study of over 160,000 postmenopausal women which is focused on the use of postmenopausal hormone therapy. They’re looking at the effect of hormone therapy on breast and colon cancer, heart disease and bone fractures.
They’re using only one drug – Prempro – in the study. Prempro is a hormone replacement drug synthesized from horse urine.

In July of 2002, results from the first part of the study were released. (The complete study goes on to 2010). Prempro was associated with slight increases in breast cancer, heart attack, blood clots and strokes.

When this news was released, Prempro sales dropped 50% in six months… you could say there was a bit of a response.

The rate of breast cancer had been steadily rising since 1945.
With the release of this new data (7.2% drop in breast cancer in 2003), Dr. Peter Ravdin, a medical oncologist and one of the study authors, said:
“Epidemiology can never prove causality”. But he said (a) the hormone hypothesis perfectly explained the data; and (b) they could find no other explanation.

Additionally, epidemiologist at the Northern California Cancer Center Dr. Christina Clarke, has analyzed cancer rates in California. She and her team used data from the National Cancer Institute and Kaiser Permanente. Not only does she show a dramatic decrease in 2003, but the trend carries forward to 2004, tho at a slower pace.

Her data for 2003 shows an 11% drop (compared to a 7.2% nationally). During 2003, Kaiser Permanente decreased their prescriptions for estrogen-progestin hormone therapies such as Prempro by 2/3rds.

These are dramatic numbers, and really, very sensical.
70% of breast cancers are estrogen positive tumors.

Let’s think about alcohol for half a moment. You may benefit from one glass of wine. But what happens if you gulp down a full bottle? It’s not such a good thing.

Back in the mid-60’s, one Doctor Robert Wilson wrote a best-selling book “Feminine Forever”. His theory was a woman should take estrogen to replace the natural decrease in estrogen that accompanies menopause. Estrogen would keep a woman more young and attractive.

There is evidence that taking certain hormones with create certain effects. For instance, taking testosterone generally will increase muscle. And taking estrogen will have some anti-aging effects.

But there are two issues:
1> like alcohol, a small amount may be beneficial; whereas, an “over dose” leads to unwanted effects.
2> For centuries, hormones prepared a woman of a certain age to conceive, carry to term and nurse babies… perpetuate the species. As well - for centuries - when women reached a certain age, hormone changes no longer supported baby production. And women’s role in society changed at that point in their life cycle. Do you think this is all haphazard?
Would you start pumping up the estrogen in a 10 year old girl so she can begin producing a family sooner?

One major role of estrogen is to prepare the body to support pregnancy and nursing. Pregnancy and nursing cause a interruption in high estrogen levels. By keeping the estrogen levels uninterruptedly high for decades after a woman partakes in child production, you’re synthetically altering what has been natural for the species for centuries.

Yes, you can synthetically alter the natural course. But very little (if anything) in nature is discreet. By altering one input to effect a desired output, you coincidentally alter a vast array of other interrelated processes and systems.

Hormone therapy – in some circumstances – is reasonable. In addition to questions of appropriateness, there are also questions of quantity and duration. Postmenopausal women were put on synthetic Hormone Replacement Therapy (HRT) for the rest of their lives. This, irrespective of what is natural/normal for a woman. Nature did not intend women to produce children until they died.

Is anyone surprised that when you go against nature, there are consequences?

Huge decline in breast cancer rate

Some very big news out today… the breast cancer rate decreased 7.2% in 2003. (Yes, 2003 data is just being released).

This decrease comes after years of increasing rates.

Naturally experts don’t know absolutely why. But the speculation is that it’s largely due to the dramatic decrease of Hormone Replacement Therapy.

It was 2002 when the Women’s Health Initiative study was released. That study showed a link between HRT use and breast cancer. Doctors had estimated that about half the women on HRT stopped after the study was released.

Time will show if the new direction of this trend sticks.
2004 stats are due out in April, 2007.

Raging hormones, raging controversy: Conventional vs Bioidentical

read time: 702 words, about 6 minutes

I caught a clip the other night on the CBS Evening News - Menopause Therapy Sparks Controversy.

Suzanne Somers has a new book out: Ageless: The Naked Truth About Bioidentical Hormones.

I haven’t read the book yet, so I’m not going to comment on it.

The news clip focused on conventional “Hormone Replacement Therapy” versus “Bioidentical Hormone Replacement Therapy”.

Let’s cover a little background…

There are three forms of Estrogen:
Estradiol - is the most potent and predominant in PRE-menopausal women
Estrone - is predominant in POST-menopausal women
Estriol - is the least potent. It’s mainly made by the placenta and most abundant during pregnancy.

Estrogen is made in the body from cholesterol (see, it does have a necessary purpose) primarily in the ovaries and adrenal glands, or, it’s converted from testosterone (yes, women have some of that too) and androstenedione in individual organs.

Additionally, the balance between Progesterone and Estrogen is also important.

OK.
Menopause is NOT a disease, it’s a natural process during which time there’s a significant change in your hormonal profile. As is the case with puberty - both for men and women.

Some women don’t experience a lot of symptoms such as hot flashes, night sweats, mood swings, anxiety, headaches, fatigue, lowered sex drive, vaginal dryness, short term memory problems and brain fog.

Some women do.

Any type of “Hormone therapy” should NOT be considered lightly. I would also submit, that the preferred goal of any hormone therapy should be short term symptom management and transition rather than lifetime subscription. That’s my opinion. I’m not prescribing. I’m not a doctor (tho I sometimes play one with myself).

OK.
Conventional Hormone therapy. The source of the hormone is from horses. Equines if you prefer a fancier word. More specifically, the urine from pregnant equines. Yes that does seem odd, but we won’t go there now.

There was a large, multi-tiered clinical trial sponsored by the National Institutes of Health called the Women’s Health Initiative.
The results of the study reported “HRT” posed more health risks than benefits.
Specifically, Prempro an estrogen-progestin therapy increased the risk of:
- Heart Disease
- Breast Cancer
- Stroke
- Blood clots
- Dementia
- Mammography abnormalities in the form of increased false positives

Premarin an estrogen only therapy increased:
- Stroke
- Mammography abnormalities in the form of increased false positives

So you have the fact that you deriving the hormone from “equines” and then you have some scary research data.

Next.
Bioidentical Hormone Therapy. Bioidentical hormones are derived from plants (phytoestrogens) - wild yam and soy. Through a pharmaceutical process they’re made into a powdered form of active hormone which is molecularly identical to our natural hormone.

A compounding pharmacist can create a blend specifically for you.

That all sounds good - yes?

I want to point out two things:
Well first, I agree - it “sounds” good.

Now, the two things…
1> testing, testing, testing. There just isn’t much in the way of data out there.
We’re just speculating on the effects. Since it’s “bio-identical”, we’re assuming it’s completely interchangeable. Maybe, maybe not.

2> the “marketing” of menopause
a) suggests a deficiency… hormone REPLACEMENT. This presumes we need hormones REPLACED, i.e., we’re lacking the proper amount.
b) And it presumes illness which requires THERAPY.

Before asking the question is bioidentical hormone therapy superior to conventional hormone therapy, shouldn’t we first look at the presumption that a POST-menopausal women is better off with a PRE-menopausal hormone profile.
Isn’t that presuming nature is wrong.

I don’t disagree that folks significantly bothered by symptoms shouldn’t work with her naturopathic or allopathic Doctor and explore hormone treatment.

But I don’t think one should presume lifelong hormone treatment should be the standard.

Also, while bioidentical hormones logically sound a lot better than equine hormones, one should keep in mind that hormones are potent. We don’t have much in the way of testing on bioidentical hormones so weighing on your decision is some level of unknown risks.

Controversy or not, this brings attention to a subject that should be getting a lot of attention. 5,700 women enter menopause every day. That’s a lot of people that need to know what that means to them on an individual basis so they can make educated choices.