We are all aware of the immediate cessation of the Women's Health Initiative (WHI) trials, involving Conventional Hormone Replacement Therapy (CHRT) due to negative outcomes noted ( i.e., increased cardiovascular and cerebrovascular disease, breast cancer, venous thromboembolic events), however we have neglected to examine the reasons and give an explanation for these negative results. This study left both the physician and patient in a quandary of whether to treat symptoms of menopause, and other signs associated with deficiencies of steroid hormones, with existing hormonal replacement therapy, or just tell the patient that no other option exists. This study, with its pessimistic results, has created further avoidance of obtaining proper treatment and proper prescribing. Keep in mind that synthetic and semi-synthetic forms of hormones were utilized in this trial.
Over the past decade, some practitioners throughout the country have been utilizing natural forms of bioidentical hormonal replacement therapy, (BHRT) to thousands of women willing to have an option. The difference with BHRT is that they are identical to the actual hormones produced by the human body, and can be custom made to the biochemical needs of that individual patient. These steroids are known as estradiol, estrone, estriol, testosterone & progesterone. The results have been excellent. BHRT are well tolerated, available in different forms (i.e. topical creams, transdermal gels, capsules or sublingual drops), have good long term compliance, but lack the large trials that are comparable to the WHI study.
We should not go back to the drawing board with HRT but should look into what we have learned thus far, and examine the mass amount of information gained in the past 40 years about steroid hormones, their metabolism and function. Following the natural physiology of the human body seems to be the first reasonable step. Bioidentical hormones have been around as long as humans, and logically we should take this route, and go forward with minimum risks.
The first point to consider with conventional hormonal replacement therapy (CHRT) is that of compliance. Most women have been shown to discontinue therapy due to side effects with these commercially available, patentable drugs (weight gain, breast tenderness and spotting). In some studies performed, up to 80% of women stop therapy after 4 years for this reason, 50% stopped the first year. Side effects of CHRT tell us that, for whatever reason, the body does not tolerate these adverse effects. Remember, no study is worth considering if the compliance factor is poor. Having the options to tailor therapy to accommodate individual needs and hence avoid negative effects should increase long-term compliance. And as one would suspect, compliance with BHRT is more than 90%.
To be continued...
Want more info? E-mail me at SFERZOLA@hotmail.com
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