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The "Estrogen" and HRT Controversy:
Different Sides of the Discussion Presented

by Mary Shomon

July, 2002 -- While the media has presented the results of the Women's Health Initiative (WHI) study as if the entire medical world has now agreed that hormone replacement therapy (HRT) is not recommended for women. The study showed small but increased risks of breast cancer, heart attacks, heart disease, blood clots and strokes for women who a certain type of HRT for more than four years.

The truth is that the nation's leading women's hormone and alternative medicine experts are definitely not all of one mind, and many question the results and whether they are applicable to the majority of women.

"These reports are misleading and do not present the whole truth or the limitations of this recent study," says Elizabeth Lee Vliet, MD, author of "Screaming to Be Heard." You can read an entire press release from Dr. Vliet at (PDF format). But Dr. Vliet basically says that the WHI study showed problems with one type of estrogen -- conjugated estrogens derived from horse urine -- that is found in the drug Prempro, and not 17-beta estradiol, the primary premenopausal form of estrogen. She still feels there is a role for HRT, in particular, other forms of estrogen and progesterone that more closely mimic the human hormones.

Donna Hurlock, MD, an Alexandria, Virginia-based women's hormone expert, takes great issue with the WHI findings. Overall, Dr. Hurlock does not feel that the study answers in any way the critical question that most women are facing: Should I take estrogen when I hit menopause?

According to Dr. Hurlock, this study was in post-menopausal women, most of whom were a decade past their menopause, and long past the period during which the rapid loss of estrogen has already had the greatest impact on bone loss and heart disease risk. This means that the women most likely already had a loss of bone density, and athersclerosis already in progress. Plus, with the average study participant age 63, and overweight -- nearly obese -- they were already at higher risk for heart problems and stroke.

“In the first place, I wouldn’t use Prempro in an overweight, older woman who had gone through menopause years earlier,” says Dr. Hurlock.

Hurlock feels that a more valuable study would be to evaluate women in their late 40s and 50s who are in the earliest stages of menopause -- before plummeting estrogen levels permanently affect arteries, heart and bone density. She would like to see an evaluation of the protective qualities of HRT in that younger target population. She also feels that studies of the other forms of estrogen, and studies using other forms of progesterone beyond the type found in Prempro, would also be relevant to the vast majority of women.

She summarizes her thoughts in a letter she wrote to Newsweek magazine. Dr. David Brownstein, author of The Miracle of Natural Hormones, feels that progestins are the main culprit, and that more natural forms of hormones are the answer. Brownstein provides more information online. Natural medicine guru Dr. Andrew Weil has been saying for years that there could be dangers to the popular HRT regimens in the U.S., and that risks usually outweight benefits. If women do want to take post-menopausal hormones, Weil and some of his holistic colleagues are recommending more natural forms of estrogen and progesterone, including estradiol -- available in pill form as Estrace, or as a patch, as Alora, Estraderm or Vivelle-Dot. As far as progesterone, they recommend oral micronized progesterone, in pill form, the brand is Prometrium. Even then, the holistic practitioners say that studies are needed on estradiol and natural progesterone, and they should only be used as short term solutions for menopausal symptoms. Weil recommend food sources of phytoestrogens, such as tofu, tempeh and soy milk, but does not recommend soy supplements, or designer foods spiked with soy isoflavones. While Weil offers good advice in his suggestion to avoid soy supplements, he is not the only one on the soy bandwagon. The soy industry has taken the HRT news as an opportunity increase the volume of its everpresent marketing campaign to sell women on the value of soy as a menopause remedy. Unfortunately, most of these pro-soy claims fail to mention a number of studies that have shown the negative effects of soy on the thyroid, and expert concerns regarding the hormonal effects of soy. Dr. Daniel Doerge of the Division of Biochemical Toxicology at the National Center for Toxicological Research, who is one of the nation’s top soy researchers, has published an article in the June 2002 issue of Environmental Health Perspectives, looking at the effect of soy on the thyroid. There are a variety of other experts who have also identified soy's thyroid dangers. An option to soy for thyroid patient is the south American herb/food maca. According to New York-based anthropologist and herbal expert Viana Muller, Ph.D., women who are stopping HRT may want to explore using maca root extract with one of the growing number of holistic medical doctors and other healthcare practitioners who are familiar with herbal medicine. Maca is a non-phytoestrogenic, plant sterol-based food supplement that has been shown to have some impact on menopausal symptoms. To find out about the potential use of maca, see this article from Dr. Muller.

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