Natural Medicine Clinic Publications

New Messages about the Safety of Hormone Replacement Therapy

By Nancy Aagenes, ND

"should not" The Journal of the American Medical Association published two clinical trials in early July on Premarin (conjugated equine estrogen--CEE) and Provera (medroxyprogestrone acetate--MPA, a synthetic progesterone). The combination is commonly marketed as PremPro.

The Women's Health Initiative (WHI) looked at the effect in healthy US women (age 50 to 79 years). After 5.2 years of follow-up the trial was stopped because of health risks--significantly increased were breast cancer, heart attack, stroke and thrombosis. Conclusion of the study: This HRT regimen be initiated or continued for primary prevention" of heart disease.

The other study, called HERS II, looked at women (average age 71 years) with pre-existing heart disease. The conclusion was reached that "postmenopausal hormone replacement therapy (HRT) should not be used to reduce the risk of coronary events in women who already have coronary disease."

Generating fear is not useful. First, note that the increases in disease were small--less than one-fourth of 1% in the 10,000 women studied. Second, the study showed positive results in decreased hip fracture and colon cancer.

Nonetheless, my decision-making has been influenced. Do the studies mean that PremPro is unsafe and natural hormones are safe? Natural hormones are those produced by a woman's body or prescribed substances biologically and metabolically identical to human hormone. Horse and synthetic hormones are metabolized significantly differently that the natural metabolism of human hormones. Thus, human hormone-which is what I prescribe for most of my patients-is theoretically safer.

Still remember that natural hormones were not included in the study. We cannot make the mistake of assumptions about something not studied. That is exactly what happened when conventional medicine used PremPro assuming from drug company marketing that it prevented heart disease, when in fact that had not been studied.

I will continue to evaluate each patient's symptoms and risks on an individual basis. There is no "one size fits all" in treating menopause. We will start with the powerful interventions of diet, exercise and stress reduction and continue only as far as necessary up the ladder of treatment options in this order: nutritional and botanical supplements, natural hormones, friendlier conventional medicines, saving the less friendly conventional preparations and the drugs as last options.

I have never once prescribed synthetic progesterone and will continue that policy. When women come to me on horse derived and synthetic hormone prescription I will be as aggressive as they want in tapering withdrawal. With each patient, I will consider the safest possible hormone replacement combined with non-hormonal management of menopause.