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Hormonal Happy Hour

"The Greatest Wealth you can have is Good Health"

     Dr. Angela DeRosa   

New Estrogen Study KEEPS Options Open!

 Another Great Article from Dr. Lauren Streicher, MD 

 

July 2, 2002: This is the day that will go down in medical history as the day that millions of women turned on the morning news to hear that the estrogen that they took every morning could cause cancer, heart disease, stroke and, ultimately, death. There was a collective national flush as understandably nervous, angry women tossed their hormones down the toilet. Prempro™ prescriptions immediately dropped by 70%.
 
And here we are 10 years later. Countless women are suffering with hot flashes, vaginal dryness and insomnia with the belief, propagated by the media and many doctors, that they are putting themselves at huge risk if they take hormone therapy.
 
This belief was based on findings from the Women's Health Initiative (WHI), a study that enrolled 27,000 women between 50-79 years of age to determine if postmenopausal estrogen therapy would decrease the risk of dying from cardiovascular disease.
 
Despite earlier studies that suggested otherwise, women in the WHI who used estrogen and progestin had a 28% increase in heart attacks, a 41% increase in stroke, and a 26% increase in breast cancer, and a more than two-fold increase in blood clots. No wonder women were flushing their hormones down the toilet.
 
Further analysis, however, revealed two significant flaws in the WHI study:
 
Flaw 1: The majority of the women were not newly menopausal, but were years beyond the onset of menopause. In fact, the average age of the women who participated in WHI was 63 - and 70% of the women were over 60! When the data was later divided by age group, the results in younger women were much more reassuring. We now understand the concept of a critical window. If hormone therapy is started at the onset of menopause, the risks appeared to be much lower.
 
Flaw 2: All of the women in the WHI were given an oral estrogen. It seems that transdermal estrogens, such as patches, sprays and gels applied to the skin, are safer than estrogen taken by mouth. Among other things, transdermal estrogens are not metabolized by the liver and do not appear to increase the risk of blood clots that lead to stroke, or heart attack.
 
For many years menopause experts have suspected that the data would have been very different if the study group was younger and used a different estrogen. But in the scientific community, it's one thing tosuspect something - and it's another thing to prove it.
 
That's why those of us keyed into the menopause world have eagerly awaited the results of the Kronos Early Estrogen Prevention Study (KEEPS), presented yesterday at the North American Menopause Society's annual meeting in Orlando.
 
I'll give you the headline first: Estrogen and progestogen therapy started soon after menopause, not only relieve symptoms, but appear safe.  
 
The Specifics
 
The Kronos Early Estrogen Prevention Study (KEEPS) was a four-year, randomized, double-blinded, placebo-controlled clinical trial (in other words: reliable, scientific and unbiased) of low-dose oral or transdermal estrogen and progesterone in 727 healthy women aged 42-58 who were within 3 years of the onset of menopause.
 
There were 3 groups:
*         Group 1 received oral estrogen (given as Premarin®, 0.45 mg/day - a lower dose than the 0.625 mg/day used in the WHI)
*         Group 2 received a transdermal estradiol (given by Climara® patch, 50 µg/day [µg = microgram])
*         Group 3 received a placebo (no hormone)
In women who used either oral or transdermal estrogen, there was excellent relief of symptoms. There was no increase in blood pressure, no effects on atherosclerosis, no increase in breast cancer or uterine cancer, or blood clots associated with stroke and myocardial infarction.
 
Oral estrogen was associated with an increase in HDL ("good") cholesterol along with a decrease in LDL ("bad") cholesterol. However, there was an increase in triglyceride levels.
 
Transdermal estrogen did not affect cholesterol or triglycerides, and lowered insulin resistance.
 
The bottom line is it appears to be safe for most newly menopausal women to use hormone therapy. While both oral and transdermal estrogen have minimal risks, there appear to be advantages of transdermal estrogen therapy, particularly if a women is diabetic or at risk for cardiovascular disease.
 
How long can a woman safely continue hormone therapy? No one really knows, but as the study continues, that question will be answered as well.
 
So, there you have it. The KEEPS study researchers emphasize that hormone therapy must be individualized depending on symptoms, priorities and risk factors. Estrogen isn't poison and, for the most part, miserable menopausal women can be flash-free and no longer need to feel like they are risking their lives in the name of a good night of sleep. Hallelujah.

 

Added to Women's Health, Menopause, Health News on Wed 10/03/2012

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Menopausal Women Afraid of Estrogen 10 Years After the Women's Health Initiative Study (WHI) Written by Mache Seibel, MD

Ten years after the publication of two Women's Health Initiative (WHI) studies on the risks and benefits of estrogen plus progestin in healthy postmenopausal women, millions of women suffer with menopausal symptoms because they fear these hormones. The two studies scared the hell out of women and many of their doctors (see below). But over the past 10 years, newer studies have disproven many of the original findings. But harm was done for women; the fear prevented many women from taking estrogen that could have prevented terrible symptoms. I want to help you make sense of these important studies.
 

 First, let's look at what the studies were supposed to do.
At that time, estrogen plus progestin (notice, not progesterone which is the natural hormone, but progestin, a synthetic substance that the woman's body responds to similarly to how it responds to progesterone) were being recommended for all women in menopause to lower the risk of heart disease as well as treat symptoms of menopause such as hot flashes and vaginal dryness. Postmenopausal women ages 50 to 79 (mean age 63) were given different formulations of the most common estrogen and progestin medications in use at the time.
 

Giving hormones to older women, they thought, would lower their risk of heart disease and so the study didn't take into account how old the women were, how long it had been since they started going through menopause, or if they were at risk for any other diseases. Hormone Therapy (HT) was considered both good and safe.
There were two hormone studies that were started about the same time. The first involved giving some 16,000 women either estrogen and progestin (Prempro - the most commonly used hormone of this type at the time) or placebo. That study was stopped 3 years early because the risks were greater than the benefits. Not only did  HT not protect women from heart disease, the study reported an increased risk of blood clots, stroke, heart attack and breast cancer. There was however, an equally lower risk of colon cancer and risk of breaking your hip.
 

The second study also followed a large number of women. But this group of women had their uterus removed (hysterectomy) as well as their ovaries. Women who have their uterus removed do not need to take progesterone or progestin - only estrogen. Once again, the study was stopped early because the women taking estrogen had an increased risk of stroke compared to those who took a placebo. However, compared to the women in the first study who took estrogen and progestin, these women who took estrogen only didn't have an increase of breast cancer or heart disease.
 

Postmenopausal women threw away their estrogen in droves and endured a very challenging window of time. So challenging in fact that many of my patients who initially went off their hormones called me up and within 3 to 6 months, wanted to get back on them. But in that year after the WHI was first published, between 25% and 72% of women stopped taking HT.
 

Over the past decade since those initial WHI studies were done, many of their conclusions have changed. Here are my thoughts on the highlights.
* Estrogen and progesterone, now called HT instead of HRT, is still the most effective treatment for symptoms related to menopause.
* HT is a very reasonable and safe treatment for menopausal symptoms for many women, but it can't be the only treatment we offer. Some women, especially those with a history of breast cancer or uterine bleeding or blood clots or who smoke should talk with their doctors about alternatives to HT.
* If you want to go on HT or consider going on it, there seems to be a critical window of time to start - the closer to the onset of menopause the better. Ten years after menopause, it may be too late to start HT.
* Treatment must be individualized and not assume that "one size fits all."
* Estrogen taken through the skin seems to be less of a risk for blood clots than estrogen taken by mouth.
* HT works great for preventing osteoporosis or thinning of the bones
* Estrogen only may reduce (not increase) the risk of breast cancer
* Estrogen may reduce the risk of stroke in certain subgroups of menopausal women
 

If you are interested in taking estrogen and/or progesterone or want to consider it as a possible treatment for your symptoms, talk with someone who is knowledgeable about these medications. It isn't the same as going in for an antibiotic - it will take time for the health professional to understand your personal risks, explain what the benefits and risks are for you, and provide you with an explanation of your options. When I see patients for these types of discussions, I allot nearly an hour to go over everything. Make sure you find the right person to work with you.
 

To help you prepare, CLICK HERE for a FREE EBOOK on How To Take Estrogen.
 

Diabetes Symptoms: 

It is estimated that 23 million people in the United States suffer from diabetes; unfortunately, not all of them know that they have the disease. One of the difficulties in diagnosing diabetes is that, quite often, diabetes symptoms go unnoticed. Knowing you have diabetes is the first step to learning how to live with diabetes and taking measures to lead a healthy lifestyle. Therefore, it is of great importance to know not only what causes diabetes, but to learn the signs of diabetes, and, if you exhibit these diabetes symptoms, to visit your doctor for a proper diagnosis.