Stop HRT Says Major Study

A large federal study on hormone replacement therapy (HRT) in postmenopausal women was halted on July 8, 2002 because the drugs caused an increase in the risk of invasive breast cancer.  There was also an increase in heart attack, stroke, and blood clots. There were benefits seen from HRT with a slight decrease in colon cancer and hip fractures.  These findings will be officially published in the July 17, 2002 issue of the Journal of the American Medical Association.  The full article can be read for free at: http://jama.ama-assn.org.

What to Do Now?

I would suggest you dust off your copy of the McDougall Program for Women book, which first came out in the fall of 1998.  The reported adverse effects of HRT and reasonable alternatives are thoroughly discussed in this book.  How did I know all of this long before this "new" study?  Scientific research repeats the same findings over the years, the truth surfaces for a while, and then it is buried by billions of dollars in advertisements from the pharmaceutical industries.  The reason most of my work survives the test of time is because I try to understand the basic science behind issues of nutrition and health.  Here are ten important points you need to understand about hormone replacement therapy (HRT):

1)  Menopause is a normal natural stage in a woman's life – there is a time to stop having babies, so you can live long enough to raise them.  No woman should be coerced into taking HRT by her doctors or the drug companies.

2) The benefits of HRT are small and the risks are significant.  But HRT does have a role in the medical care of some women.  HRT can be stopped (suddenly) without adverse health consequences, except for return of menopausal symptoms (like hot flashes).

3) The synthetic hormone medroxyprogesterone (Provera, also one of the two ingredients in Prempro) is the main culprit causing future health problems.  Studies over the last 20 years have shown this hormone increases the risk of breast cancer by as much as 400% and raises the risk of heart disease.  You may have read the word progestin – this refers to any substance that has progesterone-like activity – and usually means medroxyprogesterone (Provera).

4) The hormone women naturally make during their reproductive years is called progesterone. Progesterone does not increase the risk of heart disease.  In limited research it appears that progesterone may actually decrease the risk of breast cancer.  This hormone can be taken as a skin cream or pill.

5)  Estrogens increase the risk of breast and uterine cancer.  Women without a uterus may take estrogens alone (however, there still may be some benefits for the breast tissue from progesterone).  If you have a uterus you need to take progesterone to counteract some of the effects on the uterus.  It reduces, but does not eliminate, the increased cancer risk to the uterus caused by estrogen.  Estrogen also raises the risk of blood clots and gallbladder disease.

6)  Skin creams are much more potent than pills.  When a pill is taken it travels from the intestine to the liver first, where many of the ingredients are deactivated, before it is distributed to the rest of the body.  Less than 1/10th of the pill dose, when applied to the skin, will cause similar increases in blood levels of hormone.

7)  The most effective ways to prevent heart disease and osteoporosis are with a healthy diet (low-fat, no-cholesterol, low protein) and exercise.  HRT should not be primarily used for these purposes.  HRT actually increases the risk of heart disease – probably by causing blood clots to form in the heart arteries.

8)  The usual reasons I prescribe HRT for women is to counteract unpleasant symptoms: hot flashes, mood changes, and vaginal dryness.  The correct combination and dosage of HRT are determined by the woman's response to the medication.  Does she get the symptom relief she is looking for?  What is the minimum amount of hormone to accomplish this?

9)  I usually prescribe estradiol 0.05 to 0.1 mg with 20 mg of progesterone in 1 gram of a cream-base.  The directions are to apply ¼ teaspoon to the skin daily.  A small amount of testosterone (0.25 mg) can be added to the cream-base.  These preparations are not without side effects and may increase a woman's risk of uterine and breast cancer, heart disease, gallbladder disease, blood clots, as well as other problems.

10)  Herbal preparations (black cohosh, chaste berry, and others) may also result in relief of symptoms of menopause.  Their safety and efficacy are not established, but they are probably worth a trial for women seeking a non-HRT approach.

Please refer to The McDougall Program for Women for more information.  Purchase in bookstores or at www.drmcdougall.com