June 13, 2004
JAMA Study on HRT
If you own a television or radio, read any newspaper
or magazine, or even had a conversation with a friend, family member,
or co-worker, then you’ve undoubtedly heard what my newsletter and
e-letter subscribers have known for yearsconventional hormone
replacement therapy (HRT) is dangerous and should be avoided.
While I am thrilled that women across America have finally heard
loud and clear what I have been saying for years, it seems that
as many questions have been raised as answers given. I’d like to
spend our time together today helping you to sort out the findings
of the eye-opening study presented in the July 17, 2002 issue of
the Journal of the American Medical Association (JAMA), highlight
a few studies that have actually prophesized these findings, show
you how to wean yourself off of conventional HRT, and offer natural
solutions for relief from menopausal symptoms. Be sure to share
this information with all the women in your life.
Explanation of the Study
The study presented in last week’s issue
of JAMA reported on the findings from one part of the Women’s
Health Initiative (WHI), an 8.5 year project funded by the National
Institutes of Health. The WHI involves 161,809 postmenopausal women
between the ages of 50 and 79 and focuses on outlining the benefits
and risks of a variety of treatments designed to lower the incidences
of several diseases, including heart disease, breast and colon cancer,
and fractures in postmenopausal women. Of this group, 16,608 women
who were healthy and had an intact uterus participated in one part
of the WHI, which tested the effectiveness of estrogen/progestin
According to the findings, women taking estrogen/progestin
for five years or more had an increased risk for blood clots, coronary
heart disease (CHD), strokes, and breast cancer. They did find that
the treatment decreased the risk for colorectal cancer and hip fracture.
The researchers concluded that, The
results indicate that this regimen should not be initiated or continued
for primary prevention of CHD. In fact, researchers felt so
strongly about the negative implications of long-term combined HRT,
especially the unacceptably high risk for breast cancer, that they
ended the study three years early.
The Research Path Leading Up to the Study
While the national media reports that the
medical community is shocked and stunned by the results of the recent
JAMA study, I can’t help but wonder why. Reports on the risks
associated with conventional HRT have filled medical journals for
more than twenty years. Two different studies presented in 1975
in the New England Journal of Medicine found that estrogen
significantly increased the risk of cancer of the uterine lining.
In a 1997 study published in the Lancet,
researchers looked at 51 earlier studies involving a total of more
than 161,000 women. They concluded that conventional HRT increased
the risk of breast cancer with each year of use. Women using HRT
for five or more years were at 35 percent greater risk. In that
same year, the Medical Tribune reported that after ten years
of use, ERT (replacement therapy using estrogen alone) increased
a woman’s risk of dying from breast cancer by 43 percent.
In 1998, the Heart and Estrogen/progestin
Replacement Study (HERS), focused on the connection between conventional
HRT and heart disease, and involved nearly 2,800 postmenopausal
women with an average age of 67 who were given either a combination
of estrogen/progestin or placebo for about four years. All participants
had a history of heart disease.
The findings of this study, which were presented
in the August 19, 1998 issue of JAMA, found that the estrogen/progestin
combination did not prevent heart attacks nor death from coronary
heart disease, but in fact, did increase the risk for clots in the
veins and lungs.
Finally, in January 2000, concerns about
combined estrogen-progestin hormone replacement treatment identified
by a large National Cancer Institute study were reported in JAMA.
The study concluded that women who took the combined treatment for
five years had a 40 percent greater chance of developing breast
cancer than women taking estrogen alone or no hormones. Similarly,
other recent studies have confirmed an even higher 60 to 70 percent
increase in breast cancer risk with the long-term use of HRT.
One of the questions that has been posed
in every newspaper and on every television program since the release
of the JAMA findings is Now What? Many women
fear that giving up HRT means a return of dreaded menopausal symptoms
such as hot flashes, night sweats, and anxiety. For those of you
who receive my newsletter, my answer to this question is quite simpleuse
a combination of safe, natural therapies like phytoestrogens, vitamins,
and natural progesterone. Not only are these complementary treatments
gentle and highly effective, they are readily available in most
health food stores.
For relief of the symptoms associated with
menopause, as well as support for your cardiovascular system and
bones, I recommend taking the following daily dosages: 400 to
2,000 IU of vitamin E per day; 80 to 160 mg of a standardized
extract of black cohosh per day (this dose should contain a
total of 2 to 4 mg of the active component triterpenes, calculated
as 27-deoxyacteine); and/or 50 to 150 mg of soy isoflavones
You will also need to elevate your progesterone
levels with a natural form. Although it’s available by prescription
as a pill, most women prefer to use natural progesterone as a topical
cream or spray, which is absorbed through the skin. A typical dosage
of natural progesterone cream is 1/4 to 1/2 teaspoon applied to
any clean area of the skin once or twice a day (be sure it contains
400 to 600 mg of progesterone per ounce). A typical dosage of the
spray is 510 sprays per day.
Unfortunately, if you stop taking HRT cold
turkey, it is likely that your menopausal symptoms will return.
Therefore, based on a program I developed many years ago, I recommend
that when starting a natural therapy program, slowly taper down
your HRT over a period of a few months. This tapering down method
will help to prevent any menopausal symptoms from returning as you
make the transition.
If you are on estrogen only or taking two
separate prescriptions (one for estrogen, one for progestin), cut
your estrogen prescription in half each month for one or two months.
Then cut back to every other day for a month. Then cut back to twice
a week for one month, and finally to once a week for a month before
you stop. As you decrease your estrogen, begin to increase your
intake of natural estrogen substitutes like soy isoflavones, black
cohosh, or vitamin E to help cushion the estrogen withdrawal that
will occur when you stop using prescription HRT. If you are taking
a separate prescription for synthetic progestin and are on a two-
or three-week cycle with a rest period, you should finish your cycle
then switch to the natural progesterone. If you’re on a continuous
program where you are taking progestin every day of the month, you
can immediately substitute the progestin for natural progesterone.
If your HRT prescription is a single pill
combination of estrogen/progestin, cut your prescription dosage
in half each month for one to two months. Then cut back to every
other day for a month. Then cut back to twice a week for one month,
and finally to once a week for a month before you stop. As you decrease
your prescription, begin to increase your intake of natural estrogen
substitutes like soy isoflavones, black cohosh, or vitamin E to
help cushion the estrogen withdrawal that will occur when you stop
using prescription HRT. Once you are completely weaned off your
prescription and onto the natural estrogen substitutes, you should
then add natural progesterone to your regimen to support your bone
health, better sleep quality, and improve your mood.
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