Are You Hormonal?

Are you hormonal? By that I mean, are you very nurturing and compassionate (oxytocin)? Energetic (adrenalin)? Curvy (estrogen)? Calm (progesterone)? Happy (dopamine)?

Did you know that this cholesterol molecule is the building block for most hormones?

Hormones are your friends. Popular myths have made us equate hormones with negative emotions, weight gain and overall dysfunction. This is simply wrong. Working like a beautiful symphony, there are hundreds of hormones in our bodies that keep us functioning as human beings.

The focus of this blog post is on female sex hormones, specifically hormone replacement. Estrogen and progesterone are arguably the most important of these hormones and start to wane when a woman transitions to menopause or is “peri-menopausal,” When women are having a tough time during this transition, I usually recommend hormone replacement.

Hormone replacement therapy (HRT) has gotten an undeserved bad reputation. So many women suffer through menopausal symptoms because they are fearful of HRT. This is due to misinformation and poorly interpreted data. Let me explain.

The misinformation started back in 2002 with the widely publicized Women’s Health Initiative (WHI). This ground-breaking study followed over 160,000 women for over 7 years and examined several variables including diet, exercise and supplements, but the part that made the headlines was the findings regarding hormones.

There were three main “hormone” groups that were compared to each other: 1) women on estrogen and progesterone, 2) women on just estrogen alone and 3) women not taking hormones. The first group of women were shown to have increased rates of breast cancer, stroke and heart attacks, and this made for some great headlines. This part of the study was (appropriately) discontinued. What did not make headlines was the fact that group #2, estrogen-only, had fewer cases of breast cancer than placebo. This data was not available until two years later, in 2004. No big headlines, just a mention in the media between news of Ben Affeck and JLo ending their engagement, and Paris Hilton’s sex-tape. By then, damage had been done to the reputation of HRT. (And Paris Hilton, but I digress.)

The other important thing that is overlooked when examining the WHI study is this: the women were much older (average age 63) than the typical woman on HRT nowadays, the doses of hormone were much higher, and only synthetic hormones were studied. After all, much of the WHI was funded by pharmaceutical companies.

Disclosure: I recommend bio identical hormones (BHRT) to my patients seeking hormone replacement. After looking at the data–and there is a lot of data on this–I truly believe that bio identical progesterone and estrogen are superior to synthetics. They are simply safer and more effective. This is kind of heresy in the mainstream gynecologic community, but there I said it. (I already passed my boards and have a good job, so I can speak my truth!)

There are volumes written about HRT and BHRT, but a example of how bio-identical progesterone is superior to synthetic can be found in the widely quoted PEPI trial, which followed over 800 women. Micronized progesterone (bio-identical) showed a significant increase in (good) HDL cholesterol versus (synthetic) medroxyprogesterone acetate (MPA). In other studies, it has been shown to decrease coronary vasospasm compared to MPA .

For those of you not wanting a long, dry rehash of epidemiological studies, here is the take home point: If you are in peri-menopause or menopause and suffering from hot flashes, night sweats, urinary problems, vaginal dryness or brain fog, at least consider hormone therapy. Yes, even if you have a family history of breast cancer. The benefits may significantly outweigh the risks and you will likely feel better.

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