In the UK the maximum recommended time on HRT is five years, and now the American Congress of Obstetricians and Gynecologists has also revised its guidelines for effective treatment of the symptoms of menopause.
Hot flushes are the most troublesome symptom of menopause and simply replacing oestrogen, which has been the standard practice, was largely discredited by the findings of the long-term clinical trial called the Women’s Health Initiative.
It found that the most popular form of hormone replacement, a pill that combined oestrogen and synthetic progestin called Prempro, increased a woman’s risk of heart disease, breast cancer, stroke and blood clots.
New information on treatments for menopause symptoms
At the time of the WHI report, bioidentical hormones were not being widely used and the work of Dr John Lee – the pioneer of progesterone cream usage – was not well known.
Now a new bulletin, prepared by Dr. Clarisa R. Gracia, an associate professor of obstetrics and gynaecology at the University of Pennsylvania, has been published which examined the various claims and scores of studies.
It offers treatment recommendations based on the best available evidence and it seems that oestrogen alone, or in combination with a natural progesterone or synthetic progesti) for women who still have a uterus, is the “most effective therapy” for curbing hot flushes, the report found.
They made no comment on the known health risks of cancer, stroke and heart disease associated with unopposed oestrogen and the synthetic progestins which are well enough known to warrant a mention I would have thought.
Approval for transdermal hormone creams
However, the report also said that the transdermal route is considered safer as when absorbed through the skin, the hormones bypass the liver, which would otherwise create substances that might raise the risk of heart attack or cancer.
The report found little or no data to support the use of herbal remedies, vitamins, phytoestrogens (like isoflavones, soy and red clover) or acupuncture to relieve hot flushes. It did recommend “common sense lifestyle solutions” like dressing in layers, lowering room temperatures, consuming cool drinks, and avoiding alcohol and caffeine. For overweight and obese women, weight loss can also help.
These are sensible ideas, and ones most women will certainly already be aware of, and the issue of being overweight is related to the fact that oestrogen is produced in the fat cells so the more weight on the stomach, abdomen and thighs at menopause then the more oestrogen is being produced there – which will increase signs of oestrogen dominance and the associated risks.
As with hot flushes, they reported that vaginal symptoms respond best to oestrogen therapy, which can be administered through the mouth or skin or locally via a cream, tablet or ring. Because small amounts of oestrogen used vaginally can enter the bloodstream, women who have had hormone-sensitive breast cancer are advised to try non-hormonal remedies first.
The report does not specify it, but rebalancing with progesterone to oppose excess oestrogen is also recommended by Doctors experienced in bioidentical hormone usage. Also bioidentical progesterone cream can be used vaginally to help with dryness for women who cannot tolerate oestrogen.
The report is a major step forward in acknowledging that transdermal creams are the most effective method of delivering hormones. However they stop short of acknowledging the effect and benefit that bioidentical hormones like progesterone, or progesterone combined with oestrogen, have.
The medical profession is still focused on the widespread use of synthetic progestins and using only oestrogen as the most effective solution for menopause. But for those who wish to avoid HRT, and have found herbal remedies or dietary changes to be largely ineffective, then using bioidentical hormones is the solution an increasing number of women are turning to.
The positive from the report from those wishing a natural alternative to HRT is the acknowledgement that transdermal application of hormones is the most effective method – and that is exactly what you get with bioidentical hormone creams.
If you wish to read the full report in the New York Times you will find it here: