Restoring order to hormone replacement therapy: John Davis, Ph.D., N.D. clears up the recent confusion about hormone medication. (Women's Health).

After recent reports, the conventional medical world and many women in their menopausal years are extremely concerned and confused about the use of hormone replacement therapy (HRT). Reputable medical researchers, in several studies, have concluded, first that PremPro (supplemented estrogen and progesterone]) may increase the likelihood of certain cancers, especially breast cancer. What was known to only a few physicians and totally unsuspected by the rest is that supplemented estrogen does not give much, if any, help for the very reasons it was said to be prescribed ... to prevent heart disease. HRT apparently has some positive effects in the area of osteoporosis prevention. However, since both estrogen and progesterone were given, we cannot know for sure the source of that benefit. It could be progesterone alone. Many think so, but the jury is still out. We do know that weight bearing exercise is of tremendous help. Use caution, though, if osteoporosis has been diagnosed or suspected.

That should leave us with an obvious conclusion ... stop taking estrogen, or HRT! However, there is a complicating factor. Estrogen does give relief from hot flashes, the most immediate and often the most unpleasant symptom of the onset of menopause, lit also alleviates vaginal dryness and relieves depression, the second and third most unpleasant symptoms. Women understandably want their doctors to prescribe something that will give them some relief and doctors presently have nothing to offer except estrogen supplementation.

At this point in time, confused doctors to do not know what to do. As a result, many are choosing to continue to recommend HRT in spite of the data. Many are opting to focus on immediate certain consequences (reducing hot flashes), rather than consider future uncertain ones, such as cancer. If this approach continues, we will never conquer the estrogen related cancers. Fortunately, other alternatives or rather, a better approach, does exist.

Before we look at it, let's clear up some confusion. Certain truths exist. First, apparently women were not meant to have estrogen in large amounts all their lives. Even an extra year or two can be potentially harmful. Risk for breast cancer goes up in a woman even if she starts having periods early, or ceases them later than usual, especially if other risk factors are present.

Second, menopause is a normal, natural event of the aging process, not a disease. It should require treatment only when symptoms become severe, and even then the lowest level of treatment possible.

Third, some of the symptoms of menopause are caused or affected by a reduction of other hormones such as progesterone, testosterone, and DHEA. Symptoms of menopause can be worsened if certain glands are depleted or weakened, notably the adrenal glands. They are also worsened with poor nutrition. Often, if these areas are corrected or balanced and certain lifestyle changes are made, medication can be avoided.

A physician should consider the above factors, help the patient make lifestyle changes, and assess the severity of symptoms before considering HRT. Then, the proper level of HRT can be chosen.

What to Do About Symptoms

First, who can you listen to? Authors and physicians Tori Hudson and Christiane Northrup have been warning of the dangers and drawbacks of HRT for years. So has Dr. John Lee, author of What Your Doctor May Not Tell You About Menopause. Tori Hudson is a licensed Naturopathic physician specializing in women's issues. She is the author of Women's Encyclopedia of Natural Medicine. She recommends an approach to the menopausal years which most Naturopathic Physicians follow.

Next, consider certain lifestyle changes along with the possibility of hormone replacement. Diet, exercise, and stress reduction have all been shown to affect menopause symptoms. Whatever level of hormone replacement may be necessary, it should be accompanied by improvements in these three areas.

Probably the clearest and best test results have been obtained from exercise. In one study of post-menopausal women 21.5% of those who exercised experienced hot flashes, while 43.8% of non-exercisers had them. So, get busy. Fast walking will do, and yes, you do have time. Fast walking (or other aerobic exercise) along with a little work with dumb bells is even better.

Stressed out constantly? There is no doubt that stress adds extra hormonal pressure. If you are around fifty years old and still leading a high stress lifestyle, you must change it. Get help if you can't see how. It will be difficult for any method to help you if you do not solve this problem. Relaxation techniques are valuable, but lifestyle changes are even more important.

Without going into great detail here concerning diet, one thing that will help is a high quality multiple vitamin. Several vitamins and minerals have been shown to help with menopause. Get them all with a good multi-vitamin.

The same diet suggestions that are good for all of us apply here. Increase soy, fiber, fruits and vegetables. Eliminate or reduce caffeine and alcohol. They directly affect hot flashes. Buy free range and "organic" meats only. Others have been shot full of estrogen to make them grow faster. The estrogen remains in the meat to be absorbed by consumers and add to the load that may already be too high.

One of the following forms of HRT can then be added to the plan if necessary: botanical therapies, natural hormones with varying dosages, friendlier conventional hormones, or less-friendly hormones. These forms are listed from lowest risk to highest. Always start with file lowest risk and move up only if necessary. Women should use the safest level possible and for the shortest possible time. For example, many who do use some level of hormone replacement can begin weaning away from it in 6 months or so. And, by the way, these hormones should be reduced gradually, whatever the level. "Cold turkey" is too much of a shock to the body.

If a woman is already taking one of the less friendly forms, such ms Premarin, she can, with medical supervision, step down the risk ladder to "natural" hormones, and then further down at a later time.

The Levels

Level one, the safest level of hormone supplementation is botanical therapies and includes the use of phytoestrogen and herbs that have been shown to help. An example of such an herb is black cohosh. In various studies it has been shown to relieve hot flashes, depression, and vaginal atrophy. Some patience is required though. It took four weeks for the effects to appear. The dosage is one or two 40 mg. capsules twice a day. Or, in liquid form,--to 1 tsp. two times per day. Studies have shown no toxic or carcinogenic effects of black cohosh. It appears to be a safe and appropriate treatment.

Phytoestrogen (plant derived estrogen) can apparently substitute for estrogen in the body, but has a far weaker effect and apparently no side effects. Soy is the most popular example of a phytoestrogen. The optimal use of it would be to start as early as possible in life consuming about 50-150 mg. per day of soy isoflavones. If you don't like soy foods, capsules or powder are ok.

Moving up the risk ladder to level two is so called "natural" estrogen. It is called "natural" for three reasons. One, it is derived from plant sources; two, it is converted in the laboratory to the exact chemical composition of human estrogen; and three, it has no additives, binders or preservatives. The "unnatural" estrogen that has been often prescribed, (Premarin, for example) is not biochemically identical to human estrogen. One of the drawbacks of that difference is that the "foreign" estrogens apparently have an exaggerated potency in the liver. They may be harder to break down and excrete from the body, not a good thing. We want estrogen to do its job and move out.

Natural estrogen can also easily be divided into the three types of estrogen: estradiol, estrone, and estriol. Though more research is needed, at this point estriol appears to be safer than the combination. Estriol, used with acidophilus in a vaginal tablet has been shown to relieve vaginal dryness. If that is the major symptom of concern, these inserted tablets or cream may be the best answer. Consider it with your knowledgeable doctor.

Level three carries a higher risk, but possibly has the greatest effect. It is the friendlier conventional forms of HRT. These are made with micronized estradiol or estrone and have preservatives and binders in the pills and adhesive substances in the patches. There may be reason for some women to temporarily use this level of HRT. I see no reason, however, to ever again recommend the fourth level or less-friendly HRT methods.

Choose Wisely

Choosing the level of your approach is best done in consultation with an alternative-oriented M.D. or N.D. (Naturopathic Doctor). If you see an N.D., make sure he or she is licensed somewhere, even if your state does not have licensing for them.

Though the world of hormone supplementation seems to have been turned upside down, this use of lowest-level-for-the-shortest-time philosophy can restore order.

Dr. John Davis, a Naturopathic Physician, is a graduate of Bastyr University and has practices in Atlanta, Ga. and Asheville, NC. He can be reached at 404-325-7734, or 828-232-0701.