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Straight Answers to Some Tricky Questions
The following discussions are intended to help clear up some of the most glaring (and potentially dangerous) misconceptions women may have about menopause and hormones.
Q: I’m only 42, but I have symptoms. Can I hit menopause that soon?
A. Yes. About 25% of us enter menopause before the age of 47. Almost all women (95%) are in menopause by the age of 55.
Q: What’s the difference between “natural” hormones and those “bio-identical” hormones I’ve heard about? And can I buy them in the store?
A. Bio-identical means that the hormone is chemically identical to the hormone that nature produces in the human body. That is why people often refer to them as natural hormones.
Bioidentical hormones (BIH) used for hormone replacement therapy (HRT) are typically made from substances in certain yams or soybeans.
Drug manufacturers may mix these BIHs with other ingredients (including other hormones that may or may not be BIHs) or package them in certain forms (pills, patches, creams, etc.) that are sold to pharmacies under brand names.
Generic Pharmaceutical Grade (USP) hormones may be sold to “compounding pharmacies” who may mix their own hormone products prescribed by your doctor.
Some of the USP hormones may also be sold as a manufacturer’s supplement to over-the-counter (OTC) products, such as those found in health food stores.
However, not all over-the-counter “hormone” products contain hormones that the human body can use. The ones that do are much weaker than prescription drugs.
Q: If I want bio-identical, do I have to go to a pharmacy?
A. Not necessarily. You can get branded BIH on prescription at almost any pharmacy.
If the hormone type, dosage, combination, or application medium (pill, patch, cream, etc.) of the branded product does not meet your personal needs and you want your own BIH solution, you MUST use a compounding pharmacy.
Q: I was taking Prempro before the study came out that said it was bad. Am I in danger? Should I file a lawsuit?
A. Not necessarily. First, the overall risks observed in the WHI Prempro study were very small. Even in the most extreme example (blood clots), the risk increased from less than a quarter of one percent to double or less than half of one percent.
Second, you cannot sue unless you have been diagnosed with one of the diseases (heart disease, stroke, breast cancer, blood clots) that the study found to be negatively affected by Prempro.
Third, while there’s always a chance you’ll win a case if the jury is rigged right by a smart legal team, the fact is that heart disease and breast cancer data fluctuated over the 5.2 years of the study, with the Prempro group sometimes more at risk and the group with placebo is more at risk at other times.
Fourth, if you have breast cancer, you will have a hard time proving causation. (See below.)
Q: Did the WHI study show that Prempro causes breast cancer?
Answer: No. He only suggested that Prempro may accelerate the growth of an already existing breast tumor. The study was too short to determine whether Prempro causes breast tumors because breast cancer takes 7 to 10 years to grow to a detectable size. The fact is that every woman diagnosed with breast cancer during the study already had it when they enrolled.
Q: Is it true that since I have hot flashes I don’t need any treatment?
Answer: No. Hot flashes, night sweats and heart palpitations are mainly symptoms of sudden withdrawal of estrogen. Once your brain realizes that your estrogen supply is not going to increase to previous levels, no matter how loudly it screams at your ovaries, things usually calm down and these symptoms go away.
However, these obvious and unpleasant symptoms are only the tip of the iceberg when it comes to what’s going on inside your body as a result of chronically low or imbalanced hormones (usually both).
Without proper treatment, you remain at higher risk of heart disease, stroke, certain cancers, osteoporosis, and memory loss.
You are also likely to continue to experience any other symptoms you currently have, including: dryness (eyes, skin, mouth, vagina), mood changes or depression, insomnia, urinary tract infections, thinning or unwanted hair, high cholesterol, worsening allergies, body weight. profit and sexual problems.
In some cases, diet and herbs or vitamins can be effective in reducing symptoms and certain risks of the disease.
Q: Is it safer to take regular medications for things like hot flashes, cholesterol, osteoporosis, and mood/depression since the FDA says all hormones are just as risky as Prempro?
And no. But let’s deal with the second part first. The FDA’s advice that all hormones should have the same risks as Prempro and Premarin is a precaution. In the last 60 years, only Premarin-based hormones have been tested in large studies; no other HRT products are as well researched.
Arguably, the safety of our native hormones has been proven over the many thousands of years that human bodies have produced and used them. However, it is also true that chemically identical (bioidentical) pharmaceutical counterparts to the native hormones we use for HRT have never been comprehensively studied to see if they work as well or are as safe.
But don’t hold your breath waiting for those BIH studies. Since a natural formula cannot be patented, few (if any) pharmaceutical companies will want to fund expensive research into products they can never claim exclusive rights to sell at a premium price.
So the FDA’s advice is correct: until proven otherwise, assume all hormone products have about the same risks as Premarin and Prempro. (Just remember that their risks weren’t as dire as the news made them out to be, either.)
Now for the first problem: using non-hormonal drugs instead of hormones. In fact, the FDA’s recommendations on hormones should be expanded to include all medications. Only a few rare drugs have been studied for more than 5 years in more than 10,000 people, such as Premarin and Prempro. This means that the risks of these drugs you take to your heart, bones, bladder, mood, insomnia, and “personal years” are at least as unknown as the risks of bioidentical hormones.
Each drug has its own side effects, and there may be interactions between one drug and other drugs (or with foods) that increase or decrease the effect of one or more drugs you are taking.
Then there’s the complexity of taking multiple drugs in different plans, with different rules for each.
Multiple conditions that arise from a single cause should logically and most easily be treated by addressing that single cause—in this case, low or imbalanced hormones. The logical and simple answer would be to replace and/or rebalance the correct hormones. But if hormone replacement isn’t an option you’re comfortable with, don’t assume that more “regular” medications are safer.
Q: New FDA guidelines say women should use the “lowest effective dose” of hormones for the shortest possible time. Is Prempro the only product available in this strength? And is it safer than the Prempro they used in the WHI study?
Answer: “Lowest effective dose” means whatever amount is suitable for your body to solve the targeted problems. Every woman is different; therefore, no product can realistically offer a universal “lowest effective dose”, although many products offer low-dose options.
The fact is that even the lowest dose of Prempro can be too strong for some women, while its highest dose can be too weak for others.
Because only one strength of Prempro (0.625 mg Premarin + 2.5 Provera) was used in all women in the WHI, and the low dose was not studied to the same extent, there is no evidence that the low dose is safer than the higher dose. The new option only addresses the belief that less of something risky is better for you than more.
Q: Did the big WHI study really prove that hormones don’t make you feel better?
Answer: No. The WHI’s Quality of Life (QOL) study was so poorly designed that its conclusions are laughable.
First, women with severe symptoms were discouraged from participating or encouraged to stop, leaving mostly “happy campers” in the study.
Second, even the researchers said their tests were “too crude” to really track important factors like memory.
Third (and most importantly), most subjects scored high on initial baseline QOL tests. So when later tests showed that their happy campers weren’t any happier after taking Prempro, they only proved that “if it ain’t broke, Prempro won’t fix it.”
Somehow, that bit of useless information has since morphed into the completely baseless claim that “if it’s broken, the right hormones won’t fix it.”
What you won’t hear in the news is that despite the claim that hormones don’t improve anyone’s QOL, the study showed that among the 12% of subjects with moderate to severe symptoms, there was a 77% improvement in QOL (compared to 52% for those taking the dummy pills). Now that’s a big difference!
Question: My sex drive is gone. Can Viagra work for me?
And possibly. There are currently or on the horizon products similar to Viagra for women, but the truth is that they cannot improve your libido (sex drive). What they can do is draw blood to your genitals to make the area more sensitive and likely more sensitive during sex.
But if you have no sexual desire, these drugs will not solve your problem.
Testosterone is the hormone of desire in both men and women. And when we are deficient in it, we can lose not only sex drive, but also muscle tone, bone density, memory, energy, creative passion and imagination.
Unfortunately, there is currently only one testosterone product available for women (Estratest) and it is not BIH.
Intrinsa, a new bio-identical testosterone patch for women, passed all standard tests for FDA approval, but was sent back for further testing in light of the controversy surrounding hormones in general and the use of testosterone for women in particular.
Women can use certain products designed for men, although many doctors are hesitant to prescribe them. And because of the potential for abuse, these steroids are strictly regulated.
Q: I was told that I do not need to take progesterone with estrogen because I had a hysterectomy. Is this good advice?
Answer: No. Unless the surgeon also removes your brain, bones, muscles, breasts, and almost every other organ in your body, you still need progesterone to support normal physiological functions.
Most importantly, you need progesterone to counteract the potentially harmful effects of estrogen left in your body. Even if you don’t have ovaries and have never taken estrogen, your body still makes estrogen in your fat cells and in your adrenal glands.
But in menopause, your body produces almost no progesterone, creating a dangerous “estrogen dominant” state. So even if you’re not taking estrogen, you probably still need progesterone to restore hormonal balance.
Question: Isn’t breast cancer the biggest disease risk women face?
And no! Women are 9x more likely to die from heart disease than from breast cancer! In addition, doctors are more likely to misdiagnose heart disease in women or to treat it less aggressively than in men.
Q: Isn’t lowering cholesterol essential to preventing heart disease?
Answer: No. At least half of heart attack sufferers have perfectly normal cholesterol levels!
In fact, cholesterol is not bad for you. All your hormones are made from it. Only oxidized cholesterol is bad. (This is why we take antioxidants like vitamins C and E.)
It is much more important to test for chronic inflammation, which is reflected in C-reactive protein and homocysteine levels, which are much more reliable predictors of heart disease than cholesterol.
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