Yet again, the nation’s leading authority on preventive medicine says postmenopausal women should avoid hormone replacement therapy (HRT).
The U.S. Preventive Services Task Force is standing by its original recommendation that women who have already gone through menopause should avoid using female hormones to guard against osteoporosis or diabetes, said task force chairman Dr. David Grossman, a senior investigator at the Kaiser Permanente Washington Health Research Institute in Seattle.
“Basically, the task force concluded there was no overall benefit from taking hormones to prevent chronic conditions,” Grossman said. “There are some benefits, but we believe those potential benefits are outweighed by the harms, making this essentially no net benefit overall.”
The advisory covers all formulations of hormone replacement therapy, the task force said. The therapy can consist of pills or patches containing either estrogen or an estrogen/progesterone mix.
However, women undergoing menopause can use hormone replacement therapy short-term to treat symptoms such as hot flashes and vaginal dryness, said Dr. Suzanne Fenske, an assistant professor of obstetrics, gynecology and reproductive science with the Icahn School of Medicine at Mount Sinai in New York City.
“Hormone replacement therapy does still have a benefit to women with menopause whose symptoms do not respond to other treatment options,” Fenske said. “It really should be used to manage menopausal symptoms, rather than being used for any sort of preventative medicine.”
The task force first recommended against hormone replacement therapy for postmenopausal women in 2012. It updates its recommendations every four years to make sure they reflect the latest medical evidence.
In its evidence review, the task force considered results from 18 clinical trials including more than 40,000 women.
All of the evidence suggests that combined estrogen and progesterone increase older women’s risk of breast cancer and heart disease, while estrogen alone increases the risk of stroke, blood clots and gallbladder disease, the task force said.
The task force recommendation was published online Dec. 12 in the Journal of the American Medical Association.
Even though this standard of medical practice was established in 2012, it is largely ignored. Over 50% of the gynecologists in the U.S. still recommend Premarin and Prempro, directly linked to breast cancer since their introduction in the 1960’s.
Lower dose prescriptions and bio-identical hormones carry a lower risk, but the risk persists in all HRT.
What about short-term HRT for women in early menopause? There are no clear guidelines for how long a woman can remain on hormone replacement therapy, or what dose is best for treating symptoms.
We do know that the hormone receptor sites in every cell in the body begin to down-regulate after two months of HRT. The receptors actually move from the surface of the cell down into the cytoplasm to avoid contact with circulating hormones. As a result, larger and larger doses of HRT are required to achieve the same effects.
I recommend that progesterone be limited to six months as a maximum to reduce symptoms of menopause. I use Wild Yam which is converted into progesterone in the digestive tract. I also recommend DHEA and pregnenalone for 2-3 months. These are adrenal hormones that can be converted to progesterone, estrogen and testosterone in the body. I recommend against the use of estrogen and prefer either Black Cohosh or Blue Cohosh for their estrogenic activity.
The Bottom Line:
HRT should be applied carefully and as naturally as possible. I highly recommend the DUTCH test to evaluate all the sex hormones and their metabolites. Often, it is impaired elimination of spent hormones that increases the risk for breast cancer. This can be improved with simple dietary changes.
Source: December 12, 2017 National Institutes of Health