Plain Talk about HRT Why did it take 30 years to tell Women...?
The Art and Science of Medicine, for I believe it is both, has reached new heights and plumbed new depths. The scientific breakthroughs and advances that are being made today and we can expect in the near future are mindblowing in their potential for healing. Yet in practical terms the practice of medicine is in a parlous state. The system has been overweighted toward intervention as opposed to prevention, health systems are breaking down, doctors cannot keep up with new knowledge and have been co-opted to an unhealthy degree by the major pharmaceutical companies, who’s influence is altogether too pervasive and politically potent for the practice of good medicine. Medical mistakes are the third largest cause of death in the world today and fewer and fewer people can afford effective medical care, even if it is available, or they have to wait years for treatment.
This is not a good time to be sick, people!
As consumers this is a time, as never before, that we need to inform ourselves and take responsibility for our own health and wellbeing. That does not mean ignoring the specialists. It does mean finding a good one and knowing enough to keep them honest. Think of the medical profession as you would lawyers, accountants and yes, in some cases .... car dealers.
Nowhere have the distortions of money, politics and sheer medical ignorance been more clearly demonstrated than in the case of Hormonal Replacement Therapy for women. The serious dangers of synthetic estrogen were well known to many researchers and doctors over 30 years ago and yet they were ignored. Women had to wait until 2002 before the medical profession as a whole was forced to accept that the use of synthetic estrogen was dangerous to women.
And still, most women and many of their doctors are very unclear on the subject.
In a nutshell, optimal HRT concerns six hormones. Usually only two are replaced, using equine estrogen and synthetic progestin’s. That’s where all the trouble lies. These key hormones are melatonin, estradiol, estriol, estrone, progesterone and testosterone. If you are going to replace one hormone, you have to replace all six, and you have to use hormones that are biologically identical to those of human females. Let’s examine each in turn.
Melatonin
The first hormone to decline in perimenopause is the pineal hormone melatonin. Melatonin is an essential synchronizer of the whole hormone cascade. If you replace anything, then melatonin is first on the HRT list, because, without it all other hormones lose their natural synchronicity. Imposing extra estrogen, or anything else, on a de-synchronized system is playing endocrine Russian roulette.
From thousands of cases, it has been established that 1-3 mg of melatonin, taken sublingually at night, immediately upon going to bed, raises night peak melatonin levels to within the range of a 35-year-old. It also assists sleep in perimenopause and menopause in about 60% of cases.
For many of the others, for whom melatonin does not work well, 50 mg of 5-hydroxy-tryptophan (5-HTP), a precursor of melatonin, restores sleep patterns. Any use of HRT that does not include melatonin or 5-HTP is unwise.
Estrogen
Since the 1970’s, there has been much research on hormone replacement for women, which concluded beyond doubt that horse estrogens and synthetic progestins, primarily medroxy-progesterone, caused a number of illnesses, including reproductive cancers in women.
It was also shown that these man-made drugs, which have never been a natural part of the human body, failed to protect the human brain against degeneration, and did only a poor job of protecting the heart and bones.
Numerous researchers brought the facts to public attention. Nevertheless, such is the power of pharmaceutical advertising to suppress evidence, to lobby and to hire tame scientists to fabricate opposing data, that it took until 2002 for the American Medical Association bureaucrats, not the most go-ahead organisation in the land, to finally catch on.
The fact is that no physician worth their credentials who was familiar with the evidence of their damaging effects as published in the 1980’s, and every physician should be, would ever prescribe these drugs. That they continued to be widely prescribed until 2002, AND still continue to be prescribed by physicians who don’t even read their own top medical journals, is a troubling indicator of the state of medical profession today.
The Need for HRT
Do women need HRT? Isn’t it unnatural? Shouldn’t we leave the body alone to age naturally? These are some of the confused, if not stupid questions often posed. For better or worse, humans have decided to extend their lives as far as possible, and in doing so, to remain as healthy as possible. To object to HRT is to object to contact lenses, tooth fillings, antibiotics, life-saving surgery, and all the other artificial medical procedures that extend human life and health.
Without HRT, once a woman passes the prime reproductive years and enters perimenopause between ages 35 and 45, Nature has little further use for her body, and the hormone cascade declines. And at least a thousand systems in the body decline also, most notably intelligence and memory, emotional tone, heart function, bone density, liver and kidney function, muscle strength, mobility, flexibility, and sexual function.
So what happened before HRT? All of the above plus a host of horrible symptoms. For many women, life after menopause was “nasty, brutal and short”. Fortunately women then didn’t live as long as they do now. Today with the prospect of an average female lifespan of near 90 years, HRT is essential to preserve a women’s health for half her life.
Tri-Est
The use of Tri-Est is the most advanced natural estrogen formula around and exactly duplicates the average proportions of the three estrogens in the healthy human female system before menopause. Called Esnatri in Europe, this formula is 7% estradiol, 3% estrone and 90% estriol.
The proportion of estriol is especially important, because it is anti-carcinogenic and probably acts to keep the other two estrogens under control.
Formulas, loosely called BiEst, that do not contain estrone purport to reduce carcinogenic potential, exhibit only the crudest understanding of hormonal function, and may increase hormonal mayhem in the female system. And formulas that are straight estradiol, or that contain only a small proportion of estriol, will likely prove to be as carcinogenic as horse estrogens, though it may take the same period of 25 years before the public is informed.
The amount of Esnatri (or Tri-Est) to use depends on the woman. Some are naturally low estrogen and others are high estrogen. HRT is always an experiment with any individual and may require a number of adjustments to find the optimal dose. Sensible physicians use the least amount possible, as they know they are playing with the most powerful hormones known to science. HRT should use the least triple estrogen formula that will protect a woman’s brain, organs, and bones, will eliminate menopausal symptoms and will not increase the risk of cancer.
In monitoring thousands of women on natural HRT over the last 20 years, it has been found that an effective dose yields a serum estradiol level on the low end of the normal range. For many menopausal and postmenopausal women, this is achieved with an amount of only 1.5 –2.5 mg per day, applied as a penetrating cream or gel.
As far as possible, the use of triple estrogen formulas should also mimic the natural cycle of estrogen. In healthy, cycling women, estrogen is low during menstruation and peaks between Days 12-15 (Day 1 is the first day of your period), then drops sharply at ovulation, and continues at a moderate level until days 27-28.
Externally applied estrogen in the correct small dose, builds up only slowly, taking 4-5 days to raise estrogen appreciably. Consequently, a reasonable cycle of estrogen replacement application is Days 1 through 25 of each month with no application for Days 26-28 (28 day cycle). For individuals with shorter or longer natural cycles, their physician should adapt this application program.
Progesterone
Progesterone declines even earlier during perimenopause than estrogen. As a natural hormonal component of the system, and a vital controller of estrogen, progesterone should always be used in conjunction with estrogen replacement. For many women, we have found that a cream or gel containing 25 mg of natural progesterone per dose is effective at controlling menopausal symptoms.
In healthy, cycling women progesterone is low until ovulation (Days 12-15) then raises to peak at about Days 22-24. To mimic this cycle, it has been found that progesterone application is effective if started on Days 12-14 and finished on Day 26 (28 day cycle). Different individuals respond better in terms of menopausal symptoms by using different lengths of application cycle within this range.
Testosterone
Testosteroneis the sixth vital component of hormone replacement. The first hormone to decline in perimenopause is dehydroepiandrosterone (DHEA). Women readily make testosterone from DHEA in peripheral tissues of the lungs, organs and skin. For many women, a pill of 10-25 mg of DHEA is sufficient to maintain testosterone levels. In cycling women DHEA is made daily and remains relatively stable, so should be replaced daily.
As menopause progresses, however, a small amount of testosterone, applied as a cream or gel, may be necessary to eliminate symptoms and maintain well being. It has been found that 2-5 mg per day is an effective dose range, applied on the same days as estrogen.
HRT Timing
Research to date yields the following pattern for using these hormones and precursors.
Perimenopause and Menopause:
This is based on a 28 day cycle. Day 1 is the first day of your period. Esnatri (or Tri-Est): Day 1 through Day 25. Progesterone: Day 12 through Day 25. Three days of non-use, then repeat the cycle. DHEA: 10-25 mg per day. Melatonin: 1-3 mg per day or 50 mg 5-HTP taken at bedtime.
Post-Menopause:
Choose one day of the calendar month as Day 1. (The first day of the month is the easiest). Esnatri (or Tri-Est): Day 1 through Day 30 or 31, use each day. Progesterone: Day 8 through Day 30 or 31, use progesterone each day. DHEA: 10-25 mg per day or Testosterone cream 2-5 mg per day. Melatonin: 1-3 mg per day or 50 mg 5-HTP taken at bedtime.
Notes:
1. Women who have had estrogen-fed cancers must without fail consult their endocrinologist and oncologist before taking these hormones.
2. Two excellent general books on the subject are:
“
Hormone Replacement Therapy, Yes or No?” by Betty Kamen, Ph.D.
“
Hormonal Health” by Dr. Michael Colgan.
The serious dangers of synthetic estrogen were well known to researchers 30 years ago. Why did women have to wait until 2002 to be told that? And, why are women still not being told what constitutes effective HRT? celsusAsia@yahoo.com
