Dr. Lee M.D Hormone Information (BHRT Expert)

 
Over a decade ago, Dr. John Lee first published his startling conclusions about conventional hormone replacement therapy (HRT): synthetic hormones don't work as predicted and, worse, they pose a health threat to women. His findings touched off a storm of controversy. But years later, research has proved him right. Now millions of women concerned about aging are looking for alternatives to HRT, and finding them in natural hormones, and Dr. Lee's effective, commonsense approach to restoring hormone balance.
 
Although Dr. Lee died in October 2003, his work lives on in his best-selling books, his audio and video tapes, and on this website, where you'll find a wealth of information about natural hormones, from "Frequently Asked Questions" for beginners, to biochemistry for experts.

What is a Natural Hormone?

 
SOME OF THE DIFFERENCES BETWEEN NATURAL AND SYNTHETIC HORMONES
 
Excerpted From 
 
WHAT YOUR DOCTOR MAY NOT TELL YOU ABOUT PREMENOPAUSE:
Balance Your Hormones and Your Life from Thirty to Fifty,
by John R. Lee, M.D., Jesse Hanley, M.D. and Virginia Hopkins
 
Not too long ago Dr. Lee was confronted at a conference by the owner of a large herbal products company who claimed that Dr. Lee was incorrect in referring to the progesterone used in the creams as "natural" because it was manufactured or synthesized in a laboratory, and that made it synthetic. This is a confusion in semantics that we hear frequently. In fact progesterone is far more natural to your body than any plant is because your body actually manufactures the identical substance. The progesterone manufactured in the laboratory has the identical molecular configuration of the progesterone that your body makes. It does not matter if the body makes the hormone, or a chemist makes it from a plant extract or from anything else. If it is the identical molecule, it is the identical hormone. The source of the progesterone is unimportant in this context. 
 
We usually think of the word synthetic as meaning something that is produced artificially, and is not found in nature, such as plastics and pharmaceutical drugs. For example, the "hormone" Provera is made from the same substances that natural progesterone is made from, but the molecular configuration of it is changed in the laboratory so that it is not identical to anything found in nature. But natural progesterone made in the laboratory is identical to that made in the human body. In other words, what makes a substance "synthetic" or "natural" in this context is whether or not it can be found in nature.
 
The same distinctions apply to estrogens. The two types of estrogen in Premarin taken separately are natural (found in nature) and not synthetic, but not all of the estrogen in Premarin is natural to humans. About half of it is human estrogen, and about half is horse estrogen -- a molecule not found in the human body. It's ironic that the manufacturer of Premarin has tried to advertise it as a natural product. Since about half of the estrogen in Premarin is estrone (which is natural to humans) and the other half consists of a different estrogen that is natural only to horses and is extracted from pregnant horse urine, it is natural, strictly speaking, only if you are half horse and half human! It's unfortunate that so much of estrogen research has been done with Premarin, so we don't have a truly accurate knowledge base of the effects of human estrogen versus horse estrogen. 
 
Natural estrogens extracted from wild yams or soybeans that are identical to those made by the human body are easily available by prescription in the form of creams, tablets and patches. These are estrone, estradiol and estriol, so there is no reason to take horse estrogen. Plants do not make human hormones, but some plants make compounds that have some hormonal effect. These, in their natural form, are called phytohormones ("plant-based" hormones). Although they are not the same as our hormones they may have some hormonal activity.

HRT Research

 
The Women's Health Initiative (WHI)
Conventional HRT finally gets the negative press it deserves.
Excerpted from the John R. Lee, M.D. Medical Letter
 
Last month I received an e-mail from a woman who had read one of my books and as a result had gone to her doctor and asked to be taken off of PremPro and put on natural hormones. His response was, Now why in the world would you want to do that? When she tried to explain he interrupted her, ended the visit, and left her with another prescription for PremPro. Since then, as most of you know, there have been two major studies published showing that conventional hormone replacement therapy (HRT or ERT) does more harm than good. This woman, and millions like her, deserve an apology at the very least. The first study published is from the huge Women’s Health Initiative (WHI), a portion of which was ended after five years (three years early) because of a clearly greater risk of invasive breast cancer, heart disease and strokes among women using PremPro [Premarin (equine estrogens) plus Provera (a synthetic progestin)].
 
The second study is from the Breast Cancer Detection Demonstration Project, part of a nationwide breast cancer screening program, and it showed that estrogen-only hormone replacement (ERT) increases the overall risk of ovarian cancer by more than 3-fold. Given what we’ve known for at least twenty years about unopposed estrogen’s cancer-promoting properties on a woman’s reproductive system, the concept of giving only estrogen to women without a uterus should never have taken hold in medical practice in the first place.
 
I’ll go into the WHI study in more detail shortly, but first I’d like to put these studies into a broader perspective: conventional medicine needs to change its attitudes towards women, and it needs to disentangle itself from the big drug companies.
 
What We Already Knew
It’s been evident for over a decade that HRT is only marginally effective for treating osteoporosis, and that it causes heart disease, breast cancer and strokes. I wrote about this in my first self-published book about progesterone in 1993. Why has it taken conventional medicine so long to catch up to the obvious? Drug company money and politics, what else? The two studies mentioned above were so large that the evidence could no longer be ignored, but in the meantime tens of thousands of women have been killed or permanently harmed by taking HRT. Conventional medicine, which trumpets that it is evidence-based, allowed millions of women to be given HRT without evidence that it was safe or effective. The practice of medicine in America has been hijacked by the big drug companies, who control everything from medical education, to continuing education credits, to which studies are published in our largest medical journals. Let’s get real here: drug companies are in business to make money, not to heal people. It’s the job of medicine to heal, and to the extent that American medicine allows itself to be controlled by drug companies it is not about healing, and is needlessly harming millions of people every year.
 
And then there are antiquated medical attitudes towards women. About a month ago there was an article in the New York Times about perimenopause (the years just before and after menopause). It began with the fact that Oprah had done a show on perimenopause symptoms with Dr. Christiane Northrup, and had received so many e-mails afterwards that her website server had crashed. In other words, thousands of women could relate strongly enough to the information presented that they felt inspired to send an e-mail to Oprah. For every woman who sent in an e-mail, there were undoubtedly many others who felt the same way. And yet, the rest of the Times article focused on quoting doctors who belittled the concept of perimenopause symptoms and claimed they don’t exist. The implication is that all those women were just making up their problems. This is a perfect example of how conventional medicine treats women with an attitude that says, We know better than you do what you’re experiencing and if it doesn’t fit our picture it’s all in your head, and we’ll anesthetize you emotionally with anti-depressants, or tranquilize you with anti-anxiety drugs. 
 
The same type of mistreatment has occurred with millions of women over the past two decades who have been put on conventional HRT, complained to their doctors about side effects such as weight gain, anxiety and insomnia, been told it’s all in their heads, and given anti-depressants such as Prozac or anti-anxiety drugs such as Xanax. Little did they know they were also being given heart disease, cancer and strokes. It’s likely that American doctors as a group are feeling somewhat chagrined that they’ve been handing out HRT like candy, only to find out that it can be deadly and wasn’t even effective anyway (except for controlling hot flashes and night sweats). However, their response in the media has not been encouraging. In the past two weeks I have read or heard doctors in the media claim that:
 
…it’s only 8 out of 1,000 women who are affected, which is a very small number, (The 40,000 women who have died or been seriously harmed in the past decade by HRT, and their families, may not agree.);
 
and … it’s still fine to use HRT on a short-term basis, (Do these doctors believe that cancer just suddenly appears one day out of the blue? It takes breast cancer years to develop into a noticeable mass.);
 
and … there are no alternatives to HRT that work, (Clearly they haven’t tried any alternatives.).
 
I know that to long-time readers of my books and newsletters this may be repetitive, but it needs to be said over and over: women need to take their health into their own hands; they need to trust their intuition about what’s right for them; and they need to assertively insist that their doctors listen to them. The good news is that a door has been opened for women to bring information about natural hormones to their doctors. For many doctors, it’s going to take a lot of courage to admit they’ve been misinformed, but they can make up for the harm they’ve done by opening their minds to other possibilities and looking outside of the drug company standard of care for answers. Some doctors are going to be defensive and never shift gears, but many will now be open to learning about natural hormones.
 
Million Woman Study in the UK, Published in The Lancet, Gives New Insight into HRT and Breast Cancer
A study in The Lancet (August 8, 2003) involving over a million women in the United Kingdom gives new types of evidence that conventional HRT (estrogen and progestin combinations) is associated with a substantially greater risk of breast cancer and a greater risk of dying from it. This is the largest study of its type, and the first to report an increase in risk of death from breast cancer for HRT users compared with women who have never used HRT. The Million Women Study was set up to investigate the effects of specific types of HRT on getting breast cancer and dying from it. 
 
Some 1,084,110 UK women aged 50 to 64 years were recruited into the Million Women Study between 1996 and 2001, and provided information about their use of HRT and other personal details, and were followed up for cancer incidence and death. 
 
The study found that all types of HRT, including estrogen and progestin combinations, and estrogen alone, increased the risk of breast cancer. Women who took combination hormones at the time the study began in 1996 had a 66 percent increased risk of developing breast cancer and a 22 percent greater risk of dying from it by 2002. Women taking estrogen only HRT had a 30 percent increased risk of breast cancer. 
 
This study also showed what others haven’t shown as conclusively, which is, women using the combination HRT had a higher risk of dying from breast cancer. Use of HRT by women aged 50 to 64 years in the UK over the past decade has resulted in an estimated 20,000 extra breast cancers, 15,000 of these associated with the estrogen and progestin combinations. The longer the women were on the HRT, the greater their risk of breast cancer. 
 
The only good news in the study was that the risk of breast cancer declined gradually after women stopped using it, and within five years of quitting it they had the same risk as women who had never taken it. Many and varied claims have been made that different combinations of estrogens and progestins are safer than others, or that different delivery methods, such as the patch or oral hormones are substantially safer. None of these claims were validated in this study. 
 
Dr. Lee emphasizes to his readers that conventional HRT contains synthetic progestins and not natural progesterone, and that there is no evidence that using natural progesterone as he recommends, increases the risk of breast cancer, and plenty of clinical evidence that it probably protects against breast cancer. 
 
HRT Does not Improve Quality of Life in Women Without Menopausal Symptoms
Last summer the Women’s Health Initiative (WHI) rocked the world of conventional hormone replacement therapy (HRT) when one arm of the study was halted early because of clear increased health risks to women using PremPro. (See the July and August 2002 issues of the John R. Lee, M.D. Medical Letter for details.) Now, further analysis from this study published in the New England Journal of Medicine is showing that when women who don’t have menopausal symptoms are put on PremPro, the most commonly used form of HRT, they do not experience an increase in their quality of life compared to women on a placebo. What can one say to this? Duh? If it ain’t broke, don’t fix it? However, this research was presumably done because of the habit that conventional doctors had, prior to last summer, of putting every woman over the age of fifty on a one-dose-fits-all HRT regimen. The broad consequences of that mechanistic mindset are estrogen dominance and progestin side effects, and the specific consequences, as we saw in the WHI, can range from weight gain and mood swings to fatal blood clots and breast cancer.
 
Editorial comments on the newly published research suggested that only women with menopausal symptoms should be put on PremPro, but that’s hardly the point. The point is that doctors should be measuring saliva hormone levels first, and then giving only what is deficient, in small, physiologic doses of natural hormones. (N Engl J Med. Published online March 17, 2003)

FAQ's About Progesterone Cream

 
by John R. Lee, M.D. and Virginia Hopkins
Q: What is progesterone?
 
A: Progesterone is a steroid hormone made by the corpus luteum of the ovary at ovulation, and in smaller amounts by the adrenal glands. Progesterone is manufactured in the body from the steroid hormone pregnenolone, and is a precursor to most of the other steroid hormones, including cortisol, androstenedione, the estrogens and testosterone.
In a normally cycling female, the corpus luteum produces 20 to 30 mg of progesterone daily during the luteal phase of the menstrual cycle.
Q: Why do women need progesterone?
A: Progesterone is needed in hormone replacement therapy for menopausal women for many reasons, but one of its most important roles is to balance or oppose the effects of estrogen. Unopposed estrogen creates a strong risk for breast cancer and reproductive cancers.
Estrogen levels drop only 40-60% at menopause, which is just enough to stop the menstrual cycle. But progesterone levels may drop to near zero in some women. Because progesterone is the precursor to so many other steroid hormones, its use can greatly enhance overall hormone balance after menopause. Progesterone also stimulates bone-building and thus helps protect against osteoporosis.
 
Q: Why not just use the progestin Provera as prescribed by most doctors?
A: Progesterone is preferable to the synthetic progestins such as Provera, because it is natural to the body and has no undesirable side effects when used as directed.
If you have any doubts about how different progesterone is from the progestins, remember that the placenta produces 300-400 mg of progesterone daily during the last few months of pregnancy, so we know that such levels are safe for the developing baby. But progestins, even at fractions of this dose, can cause birth defects. The progestins also cause many other side effects, including partial loss of vision, breast cancer in test dogs, an increased risk of strokes, fluid retention, migraine headaches, asthma, cardiac irregularities and depression.
 
Q: What is estrogen dominance?
A: Dr. Lee has coined the term "estrogen dominance," to describe what happens when the normal ratio or balance of estrogen to progesterone is changed by excess estrogen or inadequate progesterone. Estrogen is a potent and potentially dangerous hormone when not balanced by adequate progesterone.
Both women who have suffered from PMS and women who have suffered from menopausal symptoms, will recognize the hallmark symptoms of estrogen dominance: weight gain, bloating, mood swings, irritability, tender breasts, headaches, fatigue, depression, hypoglycemia, uterine fibroids, endometriosis, and fibrocystic breasts. Estrogen dominance is known to cause and/or contribute to cancer of the breast, ovary, endometrium (uterus), and prostate.
 
Q: Why would a premenopausal woman need progesterone cream?
A: In the ten to fifteen years before menopause, many women regularly have anovulatory cycles in which they make enough estrogen to create menstruation, but they don't make any progesterone, thus setting the stage for estrogen dominance. Using progesterone cream during anovulatory months can help prevent the symptoms of PMS.
We now know that PMS can occur despite normal progesterone levels when stress is present. Stress increases cortisol production; cortisol blockades (or competes for) progesterone receptors. Additional progesterone is required to overcome this blockade, and stress management is important.
 
Q: What is progesterone made from?
A: The USP progesterone used for hormone replacement comes from plant fats and oils, usually a substance called diosgenin which is extracted from a very specific type of wild yam that grows in Mexico, or from soybeans. In the laboratory diosgenin is chemically synthesized into real human progesterone. The other human steroid hormones, including estrogen, testosterone, progesterone and the cortisones are also nearly always synthesized from diosgenin.
Some companies are trying to sell diosgenin, which they label "wild yam extract" as a medicine or supplement, claiming that the body will then convert it into hormones as needed. While we know this can be done in the laboratory, there is no evidence that this conversion takes place in the human body.
 
Q: Where should I put the progesterone cream?
A: Because progesterone is very fat-soluble, it is easily absorbed through the skin. From subcutaneous fat, progesterone is absorbed into capillary blood. Thus absorption is best at all the skin sites where people blush: face, neck, chest, breasts, inner arms and palms of the hands.
 
Q: How safe is progesterone cream?
A: During the third trimester of pregnancy, the placenta produces about 300 mg of progesterone daily, so we know that a one-time overdose of the cream is virtually impossible. If you used a whole jar at once it might make you sleepy. However, Dr. Lee recommends that women avoid using higher than the recommended dosage to avoid hormone imbalances. More is not better when it comes to hormone balance.
 
Q: Wouldn't it be easier to just take a progesterone pill?
A: Dr. Lee recommends the transdermal cream rather than oral progesterone, because some 80% to 90% of the oral dose is lost through the liver. Thus, at least 200 to 400 mg daily is needed orally to achieve a physiologic dose of 15 to 24 mg daily. Such high doses create undesirable metabolites and unnecessarily overload the liver.

DR. JOHN R. LEE'S THREE RULES FOR HORMONE REPLACEMENT THERAPY

Use a sprinkle of common sense and a dash of logic. 
by John R. Lee, M.D. 
The recent Lancet publication of the Million Women Study (MWS) removes any lingering doubt that there’s something wrong with conventional HRT (see Million Woman Study in the UK, Published in The Lancet, Gives New Insight into HRT and Breast Cancer for details). Why would supplemental estrogen and a progestin (e.g. not real progesterone) increase a woman’s risk of breast cancer by 30 percent or more? Other studies found that these same synthetic HRT hormones increase one’s risk of heart disease and blood clots (strokes), and do nothing to prevent Alzheimer’s disease. When you pass through puberty and your sex hormones surge, they don’t make you sick—they cause your body to mature into adulthood and be healthy. But, the hormones used in conventional HRT are somehow not right—they are killing women by the tens of thousands. 
 
The question is—where do we go from here? My answer is—we go back to the basics and find out where our mistake is. I have some ideas on that. 
 
Over the years I have adopted a simple set of three rules covering hormone supplementation. When these rules are followed, women have a decreased risk of breast cancer, heart attacks, or strokes. They are much less likely to get fat, or have poor sleep, or short term memory loss, fibrocystic breasts, mood disorders or libido problems. And the rules are not complicated. 
 
Rule 1. Give hormones only to those who are truly deficient in them. 
The first rule is common sense. We don’t give insulin to someone unless we have good evidence that they need it. The same is true of thyroid, cortisol and all our hormones. Yet, conventional physicians routinely prescribe estrogen or other sex hormones without ever testing for hormone deficiency. Conventional medicine assumes that women after menopause are estrogen-deficient. This assumption is false. Twenty-five years ago I reviewed the literature on hormone levels before and after menopause, and all authorities agreed that over two-thirds (66 percent) of women up to age 80 continue to make all the estrogen they need. Since then, the evidence has become stronger. Even with ovaries removed, women make estrogen, primarily by an aromatase enzyme in body fat and breasts that converts an adrenal hormone, androstenedione, into estrone. Women with plenty of body fat may make more estrogen after menopause than skinny women make before menopause. 
 
Breast cancer specialists are so concerned about all the estrogen women make after menopause that they now use drugs to block the aromatase enzyme. Consider the irony: some conventional physicians are prescribing estrogens to treat a presumed hormone deficiency in postmenopausal women, while others are prescribing drugs that block estrogen production in postmenopausal women.
 
How does one determine if estrogen deficiency exists? Any woman still having monthly periods has plenty of estrogen. Vaginal dryness and vaginal mucosal atrophy, on the other hand, are clear signs of estrogen deficiency. Lacking these signs, the best test is the saliva hormone assay. With new and better technology, saliva hormone testing has become accurate and reliable. As might be expected, we have learned that hormone levels differ between individuals; what is normal for one person is not necessarily normal for another. Further, one must be aware that hormones work within a complex network of other hormones and metabolic mediators, something like different musicians in an orchestra. To interpret a hormone’s level, one must consider not only its absolute level but also its relative ratios with other hormones that include not only estradiol, progesterone and testosterone, but cortisol and thyroid as well.
 
For example, in healthy women without breast cancer, we find that the saliva progesterone level routinely is 200 to 300 times greater than the saliva estradiol level. In women with breast cancer, the saliva progesterone/estradiol ratio is considerably less than 200 to 1. As more investigators become more familiar with saliva hormone tests, I believe these various ratios will become more and more useful in monitoring hormone supplements. 
 
Serum or plasma blood tests for steroid hormones should be abandoned—the results so obtained are essentially irrelevant. Steroid hormones are extremely lipophilic (fat-loving) and are not soluble in serum. Steroid hormones carry their message to cells by leaving the blood flow at capillaries to enter cells where they bond with specific hormone receptors in order to convey their message to the cells. These are called “free” hormones. When eventually they circulate through the liver, they become protein-bound (enveloped by specific globulins or albumin), a process that not only seriously impedes their bioavailability but also makes them water soluble, thus facilitating their excretion in urine. Measuring the concentration of these non-bioavailable forms in urine or serum is irrelevant since it provides no clue as to the concentration of the more clinically significant “free“ (bioavailable) hormone in the blood stream. 
 
When circulating through saliva glands, the “free” non–protein-bound steroid hormone diffuses easily from blood capillaries into the saliva gland and then into saliva. Protein-bound, non-bioavailable hormones do not pass into or through the saliva gland. Thus, saliva testing is far superior to serum or urine testing in measuring bioavailable hormone levels. 
 
Serum testing is fine for glucose and proteins but not for measuring “free” steroid hormones. Fifty years of “blood” tests have led to the great confusion that now befuddles conventional medicine in regard to steroid hormone supplementation. 
 
Rule 2. Use bioidentical hormones rather than synthetic hormones. 
The second rule is also just common sense. The message of steroid hormones to target tissue cells requires bonding of the hormone with specific unique receptors in the cells. The bonding of a hormone to its receptor is determined by its molecular configuration, like a key is for a lock. Synthetic hormone molecules and molecules from different species (e.g. Premarin, which is from horses) differ in molecular configuration from endogenous (made in the body) hormones. From studies of petrochemical xenohormones, we learn that substitute synthetic hormones differ in their activity at the receptor level. In some cases, they will activate the receptor in a manner similar to the natural hormone, but in other cases the synthetic hormone will have no effect or will block the receptor completely. Thus, hormones that are not bioidentical do not provide the same total physiologic activity as the hormones they are intended to replace, and all will provoke undesirable side effects not found with the human hormone. Human insulin, for example, is preferable to pig insulin. Sex hormones identical to human (bioidentical) hormones have been available for over 50 years. 
 
Pharmaceutical companies, however, prefer synthetic hormones. Synthetic hormones (not found in nature) can be patented, whereas real (natural, bioidentical) hormones can not. Patented drugs are more profitable than non-patented drugs. Sex hormone prescription sales have made billions of dollars for pharmaceutical companies Thus is women’s health sacrificed for commercial profit. 
 
Rule 3. Use only in dosages that provide normal physiologic tissue levels. 
The third rule is a bit more complicated. Everyone would agree, I think, that dosages of hormone supplements should restore normal physiologic levels. The question is—how do you define normal physiologic levels? Hormones do not work by just floating around in circulating blood; they work by slipping out of blood capillaries to enter cells that have the proper receptors in them. As explained above, protein-bound hormones are unable to leave blood vessels and bond with intracellular receptors. They are non-bioavailable. But they are water-soluble, and thus found in serum, whereas the “free” bioavailable hormone is lipophilic and not water soluble, thus not likely to be found in serum. Serum tests do not help you measure the “free,” bioavailable form of the hormone. The answer is saliva testing.
 
It is quite simple to measure the change in saliva hormone levels when hormone supplementation is given. If more physicians did that, they would find that their usual estrogen dosages create estrogen levels 8 to 10 times greater than found in normal healthy people, and that progesterone levels are not raised by giving supplements of synthetic progestin such as medroxyprogesterone acetate (MPA). 
 
Further, saliva levels (and not serum levels) of progesterone will clearly demonstrate excellent absorption of progesterone from transdermal creams. Transdermal progesterone enters the bloodstream fully bioavailable (i.e., without being protein-bound). The progesterone increase is readily apparent in saliva testing, whereas serum will show little or no change. In fact, any rise of serum progesterone after transdermal progesterone dosing is most often a sign of excessive progesterone dosage. Saliva testing helps determine optimal dosages of supplemented steroid hormones, something that serum testing cannot do. 
 
It is important to note that conventional HRT violates all three of these rules for rational use of supplemental steroid hormones. 
 
A 10-year French study of HRT using a low-dose estradiol patch plus oral progesterone shows no increased risk of breast cancer, strokes or heart attacks. Hormone replacement therapy is a laudable goal, but it must be done correctly. HRT based on correcting hormone deficiency and restoring proper physiologic balanced tissue levels, is proposed as a more sane, successful and safe technique. 
 
Other Factors 
Hormone imbalance is not the only cause of breast cancer, strokes, and heart attacks. Other risk factors of importance include the following: 
  • Poor diet (excess sugar and refined starches, trans fatty acids, lack of needed nutrients such as omega-3 fats, full range of essential amino acids, vitamins, minerals, etc.) 
  • Environmental xenoestrogens and hormones not removed by water treatment. (Be sure that your home water filter will remove hormones.). 
  • Insulin resistance. 
  • Stress. 
  • Lifestyle problems such as excess light at night (poor sleep, melatonin deficiency), alcohol, cadmium (cigarette smoking), and birth control pills during early teens. 
 
Men share these risks equally with women. Hormone imbalance and exposure to these risk factors in men leads to earlier heart attacks, lower sperm counts and higher prostate cancer risk. 
 
Conclusion 
 
Conventional hormone replacement therapy (HRT) composed of either estrone or estradiol, with or without progestins (excluding progesterone) carries an unacceptable risk of breast cancer, heart attacks and strokes. I propose a more rational HRT using bioidentical hormones in dosages based on true needs as determined by saliva testing. In addition to proper hormone balancing, other important risk factors are described, all of which are potentially correctable. Combining hormone balancing with correction of other environmental and lifestyle factors is our best hope for reducing the present risks of breast cancer, strokes and heart attacks. 
 
A much broader discussion of all these factors can be found in the updated and revised edition of What Your Doctor May Not Tell You About Menopause and What Your Doctor May Not Tell You About Breast Cancer.

Questions and Answers About Getting Off HRT and Onto Natural Hormones

 
By John R. Lee, M.D. and Virginia Hopkins
 
What You Need to Know About Starting Bioidentical Hormone Therapy (BHRT)
How to have balanced hormones, and relief from menopausal symptoms, without using conventional HRT! 
The Women’s Health Initiative (WHI) study was canceled because of a high risk of breast cancer, heart disease and stroke associated with using HRT (hormone replacement therapy). The study analyzed the health of 16,000 women aged 50 to 79 years. After five years, those using HRT (Premarin and Provera or PremPro) had a 29 percent higher risk of breast cancer, a 26 percent higher risk of heart disease, and a 41 percent higher risk of stroke. 
 
To personalize these numbers a bit more, of the 6 million women who are using PremPro, this translates to approximately 4,200 women who got breast cancer, 4,800 women who got heart disease, and 10,800 women who had a stroke in a five-year period because they were taking this form of HRT. If we extend these numbers out over a decade, nearly 40,000 women were harmed by taking these drugs. That’s an epidemic, and doesn’t include all the women who suffered from weight gain, fatigue, depression, irritability, headaches, insomnia, bloating, low thyroid, low libido, and gallbladder disease and blood clots
 
One of the most disturbing aspects of this scenario is that it was created due to the carelessness of conventional medical practice, which dictated – without good supporting evidence of safety and efficacy – that any woman over 50 complaining about anything remotely related to menopause, be put on HRT. Their hormones weren’t measured to find out which ones they needed or how much, and they were subjected to a one-dose-fits-all mindset that created overdoses of estrogen for millions of women. Furthermore, the efficacy of progesterone in hormone replacement has been totally ignored in favor of the patentable (and therefore more profitable) synthetic counterparts known as progestins. 
 
To readers of my books and newsletters, the risks and side effects of conventional HRT are not news – the evidence of harm has been showing up in research for at least a decade. This particular study was finally large and prestigious enough that conventional medicine was forced to pay attention. 
 
Questions and Answers About Natural Hormone Replacement Therapy
Q: Do the results of the WHI apply your recommendations of using natural estrogen and progesterone ? 
A: Not at all. What I recommend is first measuring saliva hormone levels to find if there is a hormonal imbalance. Then, if necessary, correcting the imbalance using natural hormones in physiologic doses, which means ordinary doses that the body would naturally produce itself. (Please read one of our "What You Doctor May Not Tell You..." books for details.) 
 
Another way to look at this is, from puberty until menopause, a healthy woman’s body is making its own natural hormones in synchrony and balance, without giving her cancer, heart disease or strokes. What I recommend is attempting to regain this natural balance as closely as possible. 
 
Conventional HRT not only fails to measure hormones and use physiologic doses, it uses synthetic, not-found-in-nature “hormones” that are foreign to the human body and cause a long list of unwanted side effects. 
 
Q: How Do I Get Off PremPro? 
A: Most women simply need to lower their dose of estrogen and replace the progestin (the “pro” part of the PremPro) with progesterone cream. 
 
Estrogen is a prescription-only medication in the U.S., so you’ll need to ask your doctor for a separate prescription for estrogen, preferably either estradiol, or a combination of estradiol and estriol, or estriol alone (please read our breast cancer book for details on using estriol). Even Premarin, although ethically objectionable in the way it is obtained from pregnant mares, will work if it is used in the lowest dose needed, and in combination with natural progesterone. If you discontinue estrogen suddenly, you’re likely to suffer from hot flashes and night sweats. Hot flashes and night sweats are less likely if the estrogen dose is decreased in gradual steps. 
 
Unless your doctor already has you on a low dose of estrogen, you can begin with half the dose you have been taking when you add progesterone cream in place of the progestin. Many menopausal women don’t need any estrogen at all, and can gradually taper (over 3-4 months) their dose down to nothing. Although transdermal progesterone alone will alleviate menopausal symptoms for many women some women may need a little bit of estrogen to control their symptoms. Symptoms of estrogen deficiency include hot flashes, night sweats, and vaginal dryness. Again, you can find more specific information in our books. 
 
Q: My doctor says that I can’t use estrogen and progesterone cream, because progesterone cream won’t protect my uterus the way the progestins do. 
A: Progesterone cream protects the uterus just fine. Not only did I not have any problems in my hundreds of menopausal patients before I retired from practice, I am in touch with dozens of physicians who have thousands of patients between them, who have never had a problem (some of them have been doing this for over a decade). Furthermore, soon-to-be published double-blind, placebo-controlled study by Helen Leonetti, M.D., proves that progesterone cream protects just fine. Her study compared the uterine protection of PremPro with an estrogen/progesterone cream combination. In short, the women on the progesterone cream came out just fine. 
 
You might also ask your doctor how he thinks that your premenopausal body protected itself against estrogen effects! It was the progesterone that your ovaries made every month! 
 
Q: My doctor says that because blood tests don’t show a rise in progesterone when progesterone cream is used, that it doesn’t work, and I should use oral progesterone. 
A: Blood tests only measure the serum, which is the watery part of the blood, and progesterone that comes from cream use is carried in the red blood cells, not in the serum. The most accurate way to measure hormone levels is with a saliva hormone level test, which measures your active or bioavailable hormones. When you use progesterone cream, a saliva hormone test will show a gradual rise in hormone over a three-hour period, and then it reaches a plateau for several hours and then gradually drops such that 90-% is gone after 15 hours. This amount of time is an average, and can vary a bit from woman to woman. 
 
Q: I read an article in a major magazine where a doctor is quoted as saying that natural progesterone stimulates tissue growth in the breast and therefore could contribute to breast cancer. Is this true?
A: We have tracked down the source of this information, and once again, it was a progestin, not progesterone, that stimulated the cell growth in the study being referred to. As you'll read in our books, progesterone stimulates cells to grow toward differentiation, which is an anti-cancer property. Cancer cells are undifferentiated, and thus grow without control. Progesterone also encourages cells to die when they're supposed to (which cancer cells don't do). This topic is covered in detail in What Your Doctor May Not Tell You About Breast Cancer. 
 
 
References: 
  • Writing Group for the Women's Health Initiative Investigators, "Risks and Benefits of Estrogen Plus Progestin in Health Postmenopausal Women," JAMA, July 17, 2002, Vol 288, No. 3. 
  • "Trial of HRT to prevent CHD halted early because of increased harm," Lancet, July 13, 2002, Vol 360, No. 9327. 

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