It was E.F. Schumacher that pointed out that in any enquiry or exploration, if a false or superficial beginning has been made, one may then employ the most rigorous methods during the later stages, but they will never retrieve the situation. This seems to be what has happened with the whole understanding of HRT, – (as it has with many other areas of medicine, but that is another story).
The problems have been:
1. The initial failure to understand that estrogen alone had a certain risk of encouraging the growth of cancer cells, and increasing the tendency to blood clots, therefore to heart attacks and stroke.
2. When it was realised that progesterone opposed these negative effects of estrogen, and countered these risks, the drug companies developed synthetic versions of progesterone (because the natural hormone could not be patented, – therefore no profit); which differed in molecular structure from progesterone and brought with them their own potential for similar risk factors and additional side effects.
This is perhaps not surprising when we see that bioidentical progesterone supports fertility, and the continuation of pregnancy to full term, whereas the synthetic ‘progestins’ are used in the contraceptive pill and in combined HRT, precisely for their opposite effects. In addition progesterone has a neurological and mood calming effect, whereas the synthetic versions often worsen mood swings and depression.
3. When we speak of ‘HRT’ we are including a number of different estrogens, and a larger number of different progestins, all with slightly different effects. Whether estrogens differ slightly from the body’s own is not so important, as ‘an estrogen is an estrogen’ and their physiological effects fall in a relatively narrow range. In the body, bioidentical progesterone opposes the negative side of estrogens, whereas progestins have been shown to raise the risk of breast cancer compared to estrogen alone.
The role of estrogen in cancer
It should be emphasised that estrogen does not ’cause’ cancer, but encourages all cells with estrogen receptors to multiply, including cancer cells with such receptors, – if they are already present in early form.
Many women will be ‘safe’ with estrogen, because there is no cancer present, or the immune system can compensate, but for women without a strong immune system, who are run down and debilitated, and have early an undiagnosed cancer with estrogen-positive cell receptors, then this is not a good thing to be doing. The problem is we usually do not know which women are at risk, and which are not.
The good news is women can take responsibility for their own health if they need estrogen in one of its forms, (gel, patches via the skin, oral tablets, or vaginal creams or pessaries) for hot flashes or vaginal atrophy, by using bioidentical progesterone to remove the risk factors inherent in the synthetic progestins and oppose any negative effects of estrogen.
The confusion in many doctors brought about by years of misunderstanding and misinformation from above means that NHS patients may not find it so easy to find a doctor who will prescribe estrogen-alone HRT to go along with the bioidentical progesterone. But this approach, backed up by my own experience, is to my mind physiologically the safest and most effective.
As a specific example, the recently published N.I.C.E. guidelines on Menopause found that there is minimal risk in using estrogen pessaries or cream for vaginal atrophy, as most of the estrogen is absorbed locally in the pelvic tissues, and very little finds its way into the general circulation to affect other tissues such as breast or ovary. This is important because VA is a serious, misery-inducing and under-treated condition that doctors have been wary of treating thus for some time. Hopefully this will now change, and women can also be reassured that if they add bioidentical progesterone to their regime then they are even more protected, as well as receiving the other benefits progesterone brings.
Reducing the risk from HRT is about reducing oestrogen and balancing with bioidentical progesterone so knowing what, if any, symptoms of oestrogen dominance that you have will be very helpful.