An issue to make my blood boil!
A patient told me today that her doctor had a go at her when she told her that she was on the natural hormones. It amazes me that doctors still mislead patients to this degree and are ignorant of the developments in HRT that are taking place. I also get angry that doctors will take cheap shots at me without knowing the facts. One of the reasons for this web-site is to give you the information about your hormone treatment, from the best sources available.
At last the mainstream(some of them anyway) medical profession has woken up at last to something women have realized for many years. A recent study (published below) in a mainstream medical journal, has accepted the fact that BHRT is preferred by women, has extra safety built in, and leads to less side effects. The result is that a pharmaceutical company is now producing natural estrogen and natural progesterone in a pill to compete with the form that women have been getting it in the past.
To quote from the article”. An increase in the use of compounded bioidentical hormone therapy (CBHT) has occurred in the United States, indicating that women appear to be concerned with the hormones contained in FDA-approved HT. Using a combination of cross-sectional Internet survey data, US Census Bureau statistics, and PHAST 2.0 prescription data, a recent US study estimated that Compounded BHT may account for 28% to 68% of all HT prescriptions and may be used by 1 to 2.5 million women aged ≥40 years annually, accounting for $1 to $2 billion in health care spending every year”
Comparison of progestogen effects on the breast
The impact of HT on the breast is a significant concern. While both CEE “Premarin” and estradiol stimulate breast cancer cell proliferation, it is the progestogen component that likely has the greatest influence on breast cancer risk with HT. See my blog of the 11th June about the study from France, where natural progesterone is much more popular than the synthetic forms.
The type of progestogen can also influence the incidence of breast cancer. Observational studies have reported that oral estrogens plus micronized progesterone has less effect on increasing breast cancer risk than oral estrogens with various synthetic progestins. A more detailed analysis of the E3N study showed estrogens plus dydrogesterone significantly increased lobular breast cancer and that estrogens plus other progestins significantly increased ductal, lobular, pure lobular and mixed ductal/lobular cancer, but that estrogens plus progesterone did not increase any of these breast cancer subtypes . In addition, differences in mammographic breast density and abnormalities have been reported between progestogens. Mammographic breast density and breast cancer cell proliferation significantly increased in studies of postmenopausal women receiving CEE/MPA(synthetic hormones) but these parameters did not increase with administration of transdermal estradiol with oral micronized progesterone. The progestin drospirenone (DRSP) has been shown to significantly increase breast density when used in combination with estrogen in perimenopausal women.
Furthermore, the study says:
Review of reported differences between estrogens and progestogens
As discussed above, TX-001HR(the new BHRT produced by a drug company) contains estradiol and progesterone combined in a single capsule. This formulation is expected to offer both efficacy and safety for treating menopausal symptoms in women with a uterus, as suggested by preliminary data on the bioequivalence of the new capsule formulation to separate approved estradiol and approved progesterone products. Published data suggests that this hormone formulation may represent a safer alternative than existing HT regimens. The following review of the literature supports the use of natural estrogen combined with natural progesterone over other combinations of estrogens and synthetic progestins.”
Also” a cross-sectional study of 176 women who had previously switched from HT containing MPA to HT containing micronized progesterone, 71% had switched because of the better side effect profile, 35% because they believed the long-term risks would be fewer, and 23% because of intolerance to MPA. When evaluated at 1 to 6 months after switching, the women experienced significantly better quality of life, including less depression and anxiety, than with MPA (both P < 0.001) . Patient satisfaction questionnaires also indicated that women preferred micronized progesterone over their previous regimen for better symptom control and fewer adverse effects. In the study by Ryan and Rosner of CEE with either progesterone or MPA, results on the Women’s Health Questionnaire showed a significant group-by-visit interaction indicating better quality of life in the progesterone group in the cognitive difficulties domain.”
Here is the study:
17β-Estradiol and natural progesterone for menopausal hormone therapy: REPLENISH phase 3 study design of a combination capsule and evidence review.
Several formulations combining estrogens and progestins for hormone therapy (HT) have been approved worldwide for the treatment of menopausal symptoms, yet recent data indicate a decline in their use and an increase in compounded bioidentical HT. Up to now, no single product combining natural 17β-estradiol and progesterone has been approved by the US Food and Drug Administration (FDA) or the European Medicines Agency (EMA). A phase 3 trial (REPLENISH) is underway to study a novel oral formulation of solubilized 17β-estradiol and natural progesterone combined in a single gelatin capsule (TX-001HR; TherapeuticsMD, Inc, Boca Raton, FL) for treating vasomotor symptoms (VMS) in postmenopausal women. The REPLENISH trial evaluates the efficacy and safety of TX-001HR (4 doses) versus placebo for the reduction of moderate to severe VMS frequency and severity at 4 and 12 weeks and evaluates the endometrial safety of the combinations at 1 year. TX-001HR contains hormones that are molecularly identical to endogenous estradiol and progesterone and is intended as an option for women who prefer bioidentical hormones; further, it does not contain peanut oil, a common allergen. The constituents of TX-001HR, in a pharmacokinetic report, showed similar bioavailability and safety compared with reference estradiol tablets and micronized progesterone capsules administered together. Published data suggest a safer profile of estradiol and natural progesterone compared with HT containing conjugated equine estrogens and progestins. This report summarizes the methodology of the REPLENISH trial and reviews the evidence suggesting clinical differences between HT containing progesterone or progestins, and estradiol or conjugated equine estrogens.
Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
If you can wade through all the medical language, the conclusion is that women prefer the natural HRT because all studies show that they have a better quality of life, and are safer than the alternative. So why, oh why, are so many doctors still ignorant of these facts? Now you know why I get so mad over this, because I hate the fact that women are being sold short with hormones that have greater risks of harm.