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Fear-Free Facts about HRT
by Laura Power, M.S., Ph.D., L.N.

Fears concerning estrogen replacement are exaggerated and based on faulty research. They are all based on one research study done 20 years ago, with excessively high levels of Premarin, a synthetic estrogen which contains more than 9 non-human forms of estrogen made from mare’s urine. Hence higher rates of cancer for women on this synthetic HRT regime. Humans have 3 estrogens: estradiol for pre-menopause, estriol for pregnancy, and estrone for post-menopause. There is some older research suggesting a higher rate of cancer with estrone replacement, but the accuracy of the study is unknown (the analysis did not control for age and other factors.) Two large newer research studies show that lower levels of human estrogen do not cause high rates of breast or uterine cancer. So when you read media reports of “another study” suggesting HRT is bad, keep in mind there are different forms of estrogen, and these studies are based on obsolete synthetic forms.

What hormones are important to women after menopause?

Estrogen is necessary for: short-term memory (even in males), vaginal lubrication, bone density, maintaining breasts, and proper sleep patterns. It may prevent hot flashes, heart disease, and possibly Alzheimer’s disease.

Progesterone is beneficial in small amounts, because it reduces the build up of the uterine lining. But in large amounts it causes rapid weight gain because it is a pregnancy hormone. It slows digestion and increases food and water uptake.

Testosterone is important in women in small amounts. It controls the sex drive. It is made in the ovaries and adrenal glands before and after menopause, but begins to decline 5 to 7 years after menopause. Excess testosterone can cause acne and facial hair in women.

DHEA is the "Mother Hormone.” It converts to other steroid hormones (estrogen, progesterone, testosterone, and cortisol). It is also very important for ENERGY, sleep, and muscle tone (muscles more in men than women). It declines 3 percent a year every year until we have none and die. It is important to begin replacing it around age 50. To test your levels, there are blood or saliva tests for DHEA-S. (Do not test for plain DHEA since levels vary extremely.)

Pregnenolone is another important hormone but it converts more to cortisol than sex hormones. It is best in small doses for improved energy. Like DHEA, Pregnenolone can be purchased over the counter.

The best forms of hormones are those that are identical to our natural hormones. The best sources are made from plants such as yam, soy and peanut. These prevent side effects (unless you have allergies!) Doses can be adjusted individually for each woman. The best estrogen is natural estradiol made from soy, at 0.5-1 mg/day. The best progesterone is natural micronized progesterone, at 25-100 mg/day. These are now available in prescription form as Estrace (from soy) and Prometrium (from peanut).

Alternatives to natural HRT include: additional soy to diet (not adequate by itself), the herb black cohash, and Remifemin (black cohash extract used for 40 years in Germany). These are good for women who have had cancer.

If you are in the Maryland, Washington DC or Virginia area, I refer you to these gynecologists:

  • Dr. Melissa Thiel, Alexandria, Virginia, 703-823-4770
  • Dr. Donna Hurlock, Alexandria, Virginia, 703-823-1533
  • Dr. Emine Cay-Masters, Fairfax, Virginia, 703-532-2200
  • Dr. Zidi Berger, Rockville, Maryland, 301-279-0488
  • Dr. Rebecca Douglas, Washington, D. C., 202-223-4540
  • Dr. John Bruchalski, Fairfax, Virginia, 703-273-9440

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