By Dr. Angela DeRosa –
The media is at it again…scaring women about hormones and doing it in a fashion that I would consider negligent. It seems every week there is a new article or publication claiming hormones are “bad” for women. While it appears from the headlines that these studies are “new,” many people do not realize it is actually more data from the same Women’s Health Initiative study of women using Prempro (combination therapy with the synthetic hormones conjugated equine estrogen and medroxyprogesterone acetate, MPA, progestin) that was first reported in 2002.
Since the Prempro part of the study was stopped, researchers are publishing only the data analysis from this group, not data from the women taking estrogen (Premarin) alone. What consumers do not realize is that it is common in academic medicine for the same study population data to be “mined” (or analyzed) for multiple publications on different topics. Rather than put all of the data analyses into one publication, a series of publications based on the same study group may be published over several years as the researchers consider different variables.
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For women and physicians, it is confusing, because it seems another concern hits the news every other week. Unfortunately, the headlines make it sound like this is yet another different study adding more fuel to the fire. In fact, it is simply more data from the same study, and the same combination of horse-derived estrogen and synthetic progestin (Prempro) being given to elderly women.
Most women’s health and hormonal experts would agree that Premarin and Prempro are poor choices for hormonal therapy. The estrogen is a synthetic estrogen made from horse’s urine (not the bio-identical estrogen made by a women’s ovary) and it is an oral delivery of estrogen, which can increase a women’s risk for cardiovascular effects. Oral hormones have to process through the liver; called first pass liver metabolism. This type of processing allows for blood-clotting factors to be released which can increase a person’s risk for blood clots, heart attack and stroke.
In addition, many physicians and researchers think that many of the adverse outcomes found in the PremPro arm of the study are more likely due to the particular progestin being used (Provera or medroxyprogesterone acetate), since earlier studies have shown that this progestin negates the beneficial effects of estrogen.
It is very important to ensure that women who have had a hysterectomy avoid taking progestin or progesterone unless there is a clear medical reason to do so. If a woman requires Progesterone they should only take one, which is bio-identical such as Prometrium or compounded Progesterone like the one our body’s ovaries make.
These characteristics make Premarin and Prempro dangerous medications, but to say that all hormones are bad is just not true and is not based on scientific data.
Premarin and Prempro used in the WHI are not the same hormones made by our body, and the WHI study is not looking at the difference in the types and routes of delivery for the many other forms of hormone replacement therapy available. This study should not blanket over all estrogens. Non oral, bio-identical hormones have decades of data to support the positive effects especially when delivered via a subcutaneous method such as with bio-identical pellets.
Recent news stories also cover up the fact that the risk increases reported from the WHI were seen only with the Prempro group (combined daily progestin and estrogen). The Premarin (conjugated equine estrogen alone) group of women did not have these risks, and the women in that group who had had a hysterectomy and could take estrogen alone, ARE continuing the study. Early data suggests that the Premarin treatment group are deriving multiple benefits from a cardiovascular standpoint, decrease in breast cancer and osteoporosis, etc. Even with the worst possible estrogen preparation on the market for women is showing benefits.
To make matters worse, most physicians are as confused by this data as their patients. They do not have the time to sort through all the data, and they often say “there is no data to support other forms of hormonal delivery.” If your healthcare provider says this, they are wrong. There is a big difference between “no data” and not having read the data. Lastly, there is a great fear of lawsuit in this country and many providers do not want to put themselves at risk. It is easier to not prescribe proper hormones than spend the time and energy to educate themselves and their patients on the “true data, risks and benefits and possible short/long term effects”. Lastly, time has become short in physician practices and they do not have the luxury to take the much-needed time to have these discussions.
So before you “throw the baby out with the bath water,” I encourage you to educate yourself on the real data, talk to experts who study women’s health and others who have dedicated their careers to understanding the data and question everything the media says about health and hormones in particular. You won’t be sorry.
1 thought on “So Goes it with Estrogens”
I was on Prempro for an extended period of time and frankly miss it terribly. I felt you were being a bit harsh on doctors. I don’t get the sense that they don’t know or understand the data. My sense is that no estrogen therapy has been available and tested enough to ensure there are no harmful side effects. What other estrogen treatments are you referring to?