Articles

What is all the HRT Fuss About?

By Paul Hueseman, R.Ph, Pharm.D..

Are you experiencing symptoms of either perimenopause or menopause and wondering how to approach hormone replacement therapy (HRT)? Your physician may not be encouraging HRT since the abrupt cessation and findings of the Women's Health Initiative (WHI) trial in the summer of 2002. As a result, many women including Suzanne Sommers have started a crusade of searching for an alternative form of HRT to the synthetic PremPro used in this study.

Some view this trial as support for the idea that HRT should be in the form of bio-identical hormones (bHRT), and not products like PremPro or Premarin and medroxyprogesterone that are totally foreign to the human female. The concept that hormones coming from horse placentas or created in the laboratory will have positive long-term benefits in a human female simply makes no sense. The concept of bHRT is that the hormones match exactly those made by the ovaries, and therefore fit exactly on the cell receptors as nature intended. These hormones are extracted from various plants and have been available by prescription for many years.

The way the hormones are replaced is also important. Oral forms of HRT allow the hormones to go through substantial first-pass metabolism in the liver where the hormones are dramatically changed. Liver metabolism results in high estrone levels, often associated with higher risks of cancer. We also know that this metabolic process results in an elevation of creatinine reactive protein (cRP) and other pro-inflammatory markers. It is thought that this increase in cRP and other pro-inflammatory mediators negates the heart benefits of estrogen.

While the WHI trial was ended early it did show a reduction in fractures, conferring protection from osteoporosis when replacing hormones. There have been other studies showing positive benefits of bHRT in reducing the risk of heart disease, osteoporosis, stroke, cancer and Alzheimer's disease. Generally, these studies showed no increased risk of breast or endometrial cancer. Clearly, there have been contrasting results with PremPro, and the authors of the WHI trial commented that "the results of this study do not necessarily apply to other formulations of oral estrogens and progestins." In addition, they stated that "it remains possible that estradiol with progesterone, which more closely mimics the normal physiology and metabolism of endogenous sex hormones, may provide a different risk-benefit profile".

Compounded bHRT offers alternatives to commercial synthetic hormones. Compounded bHRT is identical to the hormones produced by the ovary, is customized to the dose that is right for you and can be formulated in a sublingual or topical, dosage form, both bypassing the liver metabolism. Bellevue Pharmacy Solutions is a state of the art compounding pharmacy with a staff of consultant pharmacists who will work with you and your physician to find your HRT solution. For more information, please contact us at 800-728-0288.