Taken from the May/June 2009 issue of the Women's Health Activist Newsletter.
Let’s get a few things straight right off the bat. Hormones won’t make you look like Suzanne Somers. Hormones won’t make you young again. Nothing will make you young again. You will age, unless you die.
OK, just had to get that out of our systems. Certainly, we all want to stay healthy as long as possible. Many practices contribute to healthy aging, including exercise, not smoking, and avoiding heavy alcohol use. Enjoyable activities help too, like socializing, getting enough sleep, relaxing and having fun. But, alas, there’s no magic pill (or cream) and Ms. Somers’ promotion of hormone drugs hurts women’s health. The truth is, post-menopausal use of hormones has well-known dangers.
First, let’s address menopausal hormone therapy (HT) in general. HT should only be used for bothersome hot flashes or bothersome vaginal dryness. That’s it. Studies show that HT does not prevent cardiovascular disease, dementia or incontinence; it actually increases the risk for these diseases! There’s no evidence it prevents wrinkles, either. Women with bothersome symptoms who haven’t had a hysterectomy must take estrogen with a progestagen to prevent estrogen-induced endometrial (uterine) cancer, and some progestagens appear to increase the risk of breast cancer. Estrogens do help to preserve bone, but they increase the risk of breast cancer. Weight-bearing exercise, and taking calcium and vitamin D are a better bet.
Humans make three estrogens (estriol, estradiol, and estrone), and one progestagen (progesterone). Bioidentical hormones are a chemical match for these hormones that are synthesized in a laboratory. Preparations made in compounding pharmacies use exactly the same pharmaceutical hormones as are used in commercially available, branded hormone preparations. For example, progesterone is available in branded preparations; estradiol is common in branded hormone pills, patches, creams, and rings; and estriol is used in branded products in Europe (not the U.S.).
In a recent interview with U.S. News and World Report, Somers stated, “Our bodies weren't intended to live beyond our reproductive years. Women used to die routinely at 40 or 45, and now they're living to 90 or 100. We've figured out with technology how to keep ourselves alive twice as long as the body wants to be. When we restore our bodies to those optimal hormonal levels at which we reproduce, we keep our insides healthy because our brains are tricked into thinking we can still reproduce and keep us alive to perpetuate the species.”
This is the same ridiculous argument used to push conventional HT and it’s just plain wrong. Life expectancy is calculated as an average; if half the population dies at age 100 and half dies before age 1, the average life expectancy is 50. While it’s true that the 1900 life expectancy was only 49 years, it was mainly due to high rates of infant mortality and women dying in childbirth. In the past, women who survived both infancy and childbirth had an excellent chance of reaching a ripe old age. Hormones are more likely to shorten your life, not lengthen it.
Somers also claims that hormones prevent joint pain, dementia, and depression. In fact, studies have not shown any joint pain benefit, and menopausal HT increases the risk of dementia and age-related memory problems. Oh, and it only improves mood in women with bad hot flashes (which makes sense, because severe hot flashes disrupt sleep). Somers says, “Some women pump out hormones through their 60s and don't have a problem with menopause. Women like myself, though, who choose to work and be wives and mothers and live a high-stress lifestyle, we burn out our hormones really fast…”
In fact, estrogen levels don’t disappear after menopause; ovaries, adrenal glands, and fat tissue all make some estrogen. Anyway, menopausal symptoms don't correlate well with estrogen levels. Some women have no detectable estrogen and don’t experience hot flashes; others have high estrogen levels for their age and have terrible symptoms. The reasoning that stress burns out our ovaries doesn’t have any scientific validity, either; the real risk factors for early menopause are smoking and heart disease.
Alarmingly, Somers believes that these hormones are safe, despite the fact that she developed breast cancer while taking them! After continuing to take hormones against her doctor’s advice, she developed endometrial hyperplasia (abnormal uterine cell growth that is a risk factor for cancer). Both breast cancer and endometrial hyperplasia are known risks of HT. That, if nothing else, should cremate her credibility. Despite Somers’ claims that these hormones are safe because they have long been used in Europe, European studies have shown that estriol, like other estrogens, increases uterine cancer risk.
Progesterone or dydrogesterone (a non-bioidentical homone not available in the U.S) may cause less breast cancer than other progestagens. Other than that, no research supports the concept that bioidentical hormones have less risk than other synthesized hormones. In fact, you can’t get any more bioidentical than the hormones you produce yourself, yet women who start menses earlier or experience menopause later than average are more likely to get breast cancer. Women with naturally higher levels of hormones are also at higher risk. The longer your breast tissue is exposed to estrogen and progesterone, regardless if it comes from inside or outside your body, the higher your breast cancer risk.
Here’s our recommendation. Hormone use of any kind, bioidentical or not, should only be used for symptom relief (severe hot flashes and/or bothersome vaginal dryness) and only at the lowest doses for the shortest time possible. If you take hormones after menopause, do not take progestagen every day (a popular regimen). You can take two weeks of progesterone every three months; that will protect you from the endometrial cancer risk of estrogen and lessen your exposure to the progestagen. If you are treating vaginal dryness, use a vaginal preparation—an estrogen cream or an estrogen ring-- to lower your total estrogen exposure.
Adriane Fugh-Berman, M.D., is an associate professor in the Georgetown University School of Medicine, Dept. of Physiology, and a former chair of the NWHN.
Charlea T. Massion, MD, is a family physician and co-founder of the American College of Women's Health Physicians; she teaches at Stanford University School of Medicine’s Center for Education in Family Medicine.