One of the most common reasons for which we see a woman at PhysioAge Medical Group is to help her to decide if estrogen/progesterone replacement (HRT) is right for her and if it is, when it should be started and in what form it should be taken. The media reports about the results of the Women’s Health Initiative Trial (WHI) have fueled anxiety and concern. Doctors are refusing to start HRT on women experiencing the symptoms of menopause, and even worse, many women are being pulled off of it, even though they have been doing so well on it for years. The headlines in the lay press have proclaimed HRT to be dead.
For the past few years, however, many physicians who understand the results to the WHI have spoken out against the generalization of the results to any woman considering HRT. They rightly assert, as we have on our website, that the WHI results only apply to the two drugs that were studied, Premarin and Provera. More importantly, the majority of the women in the trial were 65 years old and had not been treated for the first 10 to 15 years of their menopause, a situation not applicable to women seeking treatment for early symptoms of menopause. Alas, such a balanced and intelligent assessment does not make for good headlines.
Then along came Susan Somers’ book The Sexy Years. Suddenly, the term ‘bioidentical hormones’ is all the rage. We are thankful that Ms. Somers’ book has raised this issue again and has focused light on the availability of safe, effective, and most importantly, individually-tailored hormone replacement therapy. The traditional method of HRT treatment is sub-standard in comparison to other forms of medical practice for conditions that, over time, lead to an increase in debility and disease. For example, would it be acceptable for a doctor to place a woman on a blood pressure medication then tell her to come back in a year to follow up without ever seeing if the medication lowered her blood pressure? Or, if that woman called in the first two months complaining of side effects, would it be acceptable for the doctor to switch her to another form and then if it causes other side effects to say, “I guess we don’t really have to treat your blood pressure.” or “You are really not a good candidate for anti-hypertensive therapy?” Yet that is exactly the way HRT has been practiced. One size fits all; no measurement of the blood levels of the hormones administered; and if side effects occur—stop the medication. This is the kind of HRT that was studied in the WHI. The results are not surprising.
Bioidentical hormones are a much better form of HRT, as you will see in the following sections. But equally important is the route of administration of these hormones, monitoring and adjustment of the therapy that continues over the course of treatment, and balancing of these hormones with others that decline in tandem as a woman ages.
The most beneficial effect of the WHI is that it has focused light on the many very important issues surrounding the decision to begin or continue HRT. The following sections will highlight each of these issues. As with many complicated issues, the first step in understanding is to define the terms of the discussion.
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