Hormone Replacement Therapy (HRT)

Declining hormones are what makes us age. Replacing lost hormones can make us look younger, feel better and live life with renewed energy – but is it safe? Every woman thinking about hormone replacement should be aware of the differences between the two types of hormones that are prescribed, synthetic and bio-identical.  Bio-identical hormones may offer an alternative that is as safe as the hormones naturally produced by the body.

Dr. Anu Arasu, Hormone Replacement Therapy

Hi. I’m Dr. Anu and today I’m going to talk about hormone replacement therapy. HRT is a really big topic for any woman going through their menopause, because they’re probably having really disabling symptoms of hot flashes, night sweats, low mood and irritability.

Hormone replacement therapy can be amazing at reducing all of those symptoms plus just increasing energy, motivation, youthful appearance, and protecting the bones and the gut. So, we already know quite a lot about HRT because it’s been in the media for all of its risks. But what do you really need to know?

First of all, there are two types of HRT. There is the synthetic type, which is the common type that’s been in the media and all the studies have been done on. And then there’s something quite new called bioidentical hormone replacement therapy and I’m going comment and talk a little bit about that later.

So, HRT received a lot of bad press in 2002 and 2004 after there were two big studies: one in America called the Women’s Health Initiative, and one in the UK called the Million Women Study. In the UK study synthetic estrogen and progesterone were looked at and they were found to cause an increased risk of breast cancer.

Now, obviously, this was quite a scare. But quite rightly, clinicians all over the world said “Hang on. We just need to interpret these studies with a bit of caution.”

At the moment, only one type of synthetic hormone has been looked at. We’re only really looked at one dose and one way of giving these medicines. Would it be different if we looked at a different type and if we gave it in a different way? That’s a really sensible question, because what we know about hormones is that their structure affects how our body cells respond to them.

What we also know is that taking a pill of estrogen isn’t the same as using an estrogen cream. If you take a pill of estrogen, it has to be processed by your liver and that produces proteins like CRP which are found in other diseases like heart disease. If you use estrogen through a cream the liver doesn’t process it. It has a different effect.
So, this has been a really interesting topic that was raised.

Following on from that, there have been some studies to look at the two differences: the synthetic hormones in one group and the bioidentical hormones in another group. There was a French study that had a look at estrogen and progestin, the synthetic one, and looked at estrogen given with progesterone, the bioidentical one. What that study found was that the estrogen with the progestin caused an increased risk of cancer, but the estrogen with the progesterone didn’t.

Now, there have been some other studies that have also shown that natural or bioidentical progesterone has a different effect from synthetic progestin. This is an area that needs more research. This is all ongoing, but it’s really interesting, and, as a result there have been lots of women internationally who have just said; “You know what? I only want to put hormones in my body that are bioidentical; identical in structure to the ones that my body is making.” Enter the world of bioidentical hormone replacement.

Here, the chemicals are actually extracted from yam and soy and they are designed to be identical to the ones that our body produces. These are so identical that if you measure the blood tests, you can’t distinguish between the ones that have been given and the ones the body produces. So, I just think it’s a really important point to bear in mind when you’re thinking about HRT, to have a think about the benefits and risks, but also to understand there are two types of HRT and the big studies are only referring to the synthetic type.

So, if you want to investigate the bioidentical hormone side, then it would be worth you speaking to a specialist in that area. I hope this has been useful. I really look forward to hearing your comments.