Dr. Lark: JAMA Study on HRT

June 13, 2004

Heart Health

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 years—conventional 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

therapy.

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.

My Recommendations

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 simple—use

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

per day.

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 5–10 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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