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Hormone Replacement Therapy Women’s Health Initiative

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Bioidentical Hormone Replacement Therapy

HRT and Women’s Health Initiative Study-Dr. Kenneth O’Kelley-Generations ObGyn

Each patient’s symptoms are unique, and so is each patient’s path to hormone optimization through BHRT using pellets. Most bioidentical hormone replacement therapy patients report some symptom resolution in as little as four weeks, but full optimization may take up to six months. The bioidentical hormones for our hormone pellet therapy will be customized to fit your patient’s specific needs.

Cognitive And Dementia Risks/benefits With Ht

Several observational studies and meta-analysis had suggested that estrogen prescribed to younger women at the onset of menopause decreases the risk of Alzheimer’s disease or delays its onset . In WHI, when older women were studied, there was a significant detrimental effect in cognitive function in women in the E+P trial and only a trend to this effect with estrogen alone . It has been hypothesized that the timing of initiation of HT is critical here, as it is for CHD. However, no RCT to date has been able to prove a cognitive benefit. In the recently completed KEEPS, preliminary data have suggested that there is no detrimental effect of HT, and indeed a trend to benefit in certain women although this short-term trial was not designed to assess the effects of HT on cognition and dementia. While we await more definitive prospective trial data, a possible benefit based on the timing of initiation of HT is consistent with the observational studies cited above as well as other observational studies that focused on the timing of initiation .

Aside From Animal Cruelty Why Horse Estrogen Isnt Right For You

To the surprise of many, Premarin stands for pregnant mare urine. And, by the way, there is probably no product manufactured on Earth involving greater cruelty to animals. Animal rights activists have been petitioning the manufacturer to come up with something more humane than impregnating and collecting the urine of 750,000 mares every year. But why should they bother? Profits from Premarin and generic variations are in the billions.

Heres the breakdown on the difference. Human female estrogen consists of three separate molecules: estrone , estradiol and estriol .

Premarin, on the other hand, is mainly estrone and equilin , the latter found only in horses and, by the way, only in horse urine, a waste product.

Although Premarin may act like a replacement for human estrogen, that fact that the estrone content is three times that found naturally in women means the match is far from perfect. And equilin is a totally foreign molecule altogether.

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Counseling Women About Ht

When counseling women, it is important to document each individual woman’s reasons for considering ET/EPT , consider the individual risks and benefits of short-term ET/EPT use, and review indications for ET/EPT annually. The WHI data are not relevant for women with premature menopause or for symptomatic menopausal women. For women younger than 50 or those at low risk for CHD, stroke, osteoporosis, and breast or colon cancer, the absolute risk or benefit from ET or EPT is likely to be even smaller than for the women in the WHI, although the relative increase in risk may be similar.17,18

The Women’s Health Initiative

Finding a balance with hormone replacement therapy

The Women’s Health Initiative was a prospective, randomized, double-blind, placebo-controlled study of more than 16 000 healthy, postmenopausal women between the ages of 50 and 79, who received either estrogen plus progestin , estrogen alone , or a placebo. The primary outcome studied was the effect of the 2 treatment types on prevention of cardiovascular disease , breast and colorectal cancer, and bone fractures. A separate study of women over 65 enrolled in the WHI assessed the effects on dementia and Alzheimer’s disease . Neither study was designed to assess the effect of the specific hormone treatment on hot flashes or vaginal dryness. Four percent of WHI participants had moderate to severe vasomotor symptoms .

Event-Attributable Risk or Benefit Per 10 000 Women/Year*


*Numerals in parentheses indicate absolute increases in risk or benefit attributable to either EPT or ET. That is, a risk of 6 means that 6 additional cases of a given outcome were experienced among subjects who received HT than among subjects on placebo.1,2,3,4,5,6,7,8Source: WHI

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Secondary Endpoints In The Two Trials: Intervention And Post

The results for other clinical endpoints in the trial are summarized below, with more details available in the online Appendix.

Myocardial Infarction

Overall, results for MI were similar to those for CHD . However, differences by age or time since menopause emerged during the intervention phase of both trials. For CEE+MPA, statistically significant differences were apparent by time since menopause but not by age . For CEE, the HRs increased with increasing decade of age . Cumulatively, the differences by time since menopause for CEE+MPA persisted and the differences by age for CEE became more pronounced .

Other secondary CVD outcomes

Results for CABG/PCI were neutral in both trials and findings for deep vein thrombosis generally paralleled those for pulmonary embolism described above . HRs were significantly elevated for total cardiovascular events during the intervention phase of both trials, but were neutral post-intervention. For cardiovascular death, results were neutral throughout .

Secondary cancer outcomes

Clinical vertebral and total fractures

In both trials, results for clinical vertebral and total fractures paralleled those for hip fracture .


Adjustment For Unmeasured Confounding

Prior observation studies have been limited by possible bias due to unmeasured confounding. We have recently devised an analytic approach that adjusts for all confounding, called the Prior Event Rate Ratio adjustment . It assumes that the ratio of the Exposed to Unexposed event rates for a specific outcome prior to the study start date reflects the combined effect of all confounders independent of any influence of treatment, provided that neither the subsequently Exposed or Unexposed groups ingested the drug undergoing study prior to the study start date. Thus when the unadjusted hazard ratio during the study is divided by the PERR, this adjusted HR corrects for all confounding.

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How To Get Started On Hrt

Speak to a GP if youre interested in starting HRT.

You can usually begin HRT as soon as you start experiencing menopausal symptoms and will not usually need to have any tests first.

A GP can explain the different types of HRT available and help you choose one thats suitable for you.

Youll usually start with a low dose, which may be increased at a later stage. It may take a few weeks to feel the effects of treatment and there may be some side effects at first.

A GP will usually recommend trying treatment for 3 months to see if it helps. If it does not, they may suggest changing your dose, or changing the type of HRT youre taking.

Evaluation Of Other Outcomes

Feds Announce New Recommendations About Hormone Replacement Therapy For Women

It is also pertinent to comment upon the findings related to breast cancer risk in both the WHI and GPRD studies. As shown in figure 1, breast cancer was increased in both the older and younger women treated with combined HT in the GPRD studies, similar to the findings in the WHI RCT. Furthermore breast cancer risk was unchanged in both the older and younger women with a prior hysterectomy treated with estrogen only in the GPRD studies, similar to the results in the WHI RCT. Additional analyses of women in both the combined HT and estrogen only GPRD studies that were not exposed to HT at any time prior to the start of the study, yielded results for breast cancer similar to the overall study cohorts.

As reported in our primary publications other outcomes, including colorectal cancer and hip fracture, largely were similar in the GPRD and WHI studies for both the comparisons of combined HT and estrogen only therapy . Venous thromboembolic events also were similar in the studies of combined hormonal therapy, but probably suffered from unmeasured confounding in the GPRD estrogen-only study, as was found for myocardial infarction and CVA.

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The Womens Health Initiative Results Then And Now

Time has given researchers more perspective on the results that came out in 2002, when women were warned that hormone replacement therapy leads to higher risks for breast cancer, cardiovascular events, blood clots, cognitive decline, and more. An extensive collection of data has been scrutinized and published, showing us that timing and individual circumstance are key.

New studies suggest that women under 60 years old and within ten years of menopause can benefit from HRT with much less risk than older women who are more than ten years away from menopause. The majority of the women enrolled in the WHI study were older and much past menopause.

In My Opinion There Were Several Flaws In The Womens Health Initiative Study:

Flaw #1. Non-Bio-identical Hormones

The hormone replacement therapy used was a combination of conjugated equine estrogens derived from the urine of pregnant horses which also contained multiple other horse estrogen hormone components foreign to the human body plus medroxyprogesterone acetate , a synthetic and non-bio-identical progesterone. Since natural hormones work like a lock and key with the human hormone cell receptors, using non-bio-identical hormones instead of the identical versions is like trying to unlock a door lock with a key that doesnt quite fit. It may partially work sometimes and not others and may even cause harm to the lock. I believe that is the reason there are many unintended consequences and adverse reactions with synthetic hormones. Failing to include natural, Bio-identical Hormones in the study was a major mistake. Having done so would have provided a much clearer and more definitive comparison between synthetic versus natural hormones, and in my opinion would have reduced or eliminated the fear and confusion that is still prevalent today.

Flaw #2. Oral Estrogens Promote Clotting Factors

Delivery of natural, bio-identical hormones through or beneath the skin bypasses the liver, just as the bodys own glands secrete natural hormones into the blood stream that travel directly to hormone receptors of virtually every cell in the body without first having to pass through the liver which eliminates the risk for clotting and inflammation.

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Formulations And Route Of Menopause Ht

Various formulations and routes are available to allow for an individualized approach to menopause care including estrogens, progestogens, and tissue selective estrogen complex . Table 1 summarizes indications and contraindications for different formulations of HT.

Table 1 Indications and contraindications for menopausal hormone therapy .

Lorenzo Diana Nd Markham Ontario Bioidentical Doctor

Hormone Replacement Therapy

Taking a naturopathic medicine approach, Lorenzo Diana, N.D. offers highly personalized naturopathic health care, gently treating disease at its root cause and strengthening the bodys own innate ability to heal. Lorenzo Diana, N.D. looks at the patients entire health as a whole when developing a treatment plan, and his mission is to get to the source of a patients condition before it become debilitating. As a Markham Ontario Bioidentical Hormone Doctor, Lorenzo Diana, N.D. has helped vast amounts of men and women to recover from the effects of aging with Bioidentical Hormone Therapy.

Dr. Lorenzo Diana has been treating patients using Naturopathic Bioidentical Hormone Support for over 17 years!

Lorenzo Diana, N.D. has developed an eclectic practice and has cultivated particular expertise in womens issues, digestive disorders, Naturopathic Oncology, Fibromyalgia, preventive healthcare and more. Since the beginning of his practice Dr. Diana has put an emphasis on naturopathic bio identical hormone support with numerous positive results.

As a first phase in his treatment protocol, Dr. Diana will conduct testing which may include: saliva hormone testing, urine tests, blood testing, allergy and nutritional testing to help identify specific hormone imbalances.

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What Implications Does The Whi Study Have For Younger Women

Unfortunately, since the study did not include women who were younger than the normal age of menopause , we have to read between the lines.

In general, the consensus among most doctors seems to be that we younger women arent in the same situation as the normal menopausal woman that were studied.

While theyre extending their exposure to estrogen beyond their early 50s, we younger women are literally replacing estrogen that wed otherwise have had if our ovaries functioned normally. So most doctors feel that this study doesnt fully apply to younger women.

To my mind, one thing is very clear: what this study DOES mean for women with POF or EM is that, at the very least, when we reach the age of normal menopause age 50 or so we should carefully re-evaluate our need for HRT.

A careful decision can then be made to determine whether to continue on it, switch to a different form or lower dosage, or taper off of it and stop taking HRT altogether.

This is something that many doctors have recommended prior to this study and the study does confirm that this is a decision we should make carefully, with consideration given to our personal health history, family history and other factors. Its also a decision that, as always, should be made by working closely with your doctor.

Hrt And Cancer There Is Strong Evidence That Using Hrt Raises A Womans Risk Of Breast Ovarian And Uterine Cancers At The Same Time It May Lower The Risk Of Colorectal Cancer

Combined HRT for menopause is a known cause of breast cancer, mainly in women who recently used or are still using the therapy. There is also some evidence suggesting that estrogen-only HRT may also increase the risk of breast cancer.

Studies suggest that both combined and estrogen-only HRT increase a womans risk of ovarian cancer but the risk is low.

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George Arnold Md Markham Ontario Bioidentical Hormone Doctor

All of the hormones in your body are designed to work together. A hormonal symphony, some would call it. If one hormone is altered, or even deficient, it can affect the actions of all of the other hormones.

No matter what symptoms you are suffering from, there is help available. Many of the women that come to see me have tried other treatments without success, because they have never been properly investigated to determine the cause of their symptoms. It is so important to first identify the cause of your hormone imbalance, for it is only then that a customized program can be put together, specifically for you, to restore balance and alleviate your symptoms.

Dr. Arnold has been in practice as an Obstetrician/Gynaecologist for 20 years. He is highly skilled in the diagnosis and treatment of hormone imbalances. Bio-identical hormone replacement is offered as the preferred option for re-establishing hormone balance. Bio-identical or natural hormones are structurally identical to the hormones your body produces.

They have not been altered the way synthetic hormones have. Doesnt it just make sense that you want to replace a deficient hormone with something identical? The end result: hormone balance is restored: safely and naturally. My patients feel themselves again. Thank-you Dr. Arnold for giving me my life back is a common and gratifying response I regularly receive.

Your Body Your Choice

WVU Medicine Health Report: Hormone Replacement Therapy (HRT) and Heart Disease

Only you can decide what is best for your body. Menopause can be a confusing time, a time when its difficult to make decisions . But know that there is an option out there for you and its okay to take your time in deciding. We have some customers who dont mind enduring the symptoms as long as they know there will be an end to them in good time. Others simply cant perform their day-to-day activities without some relief from their symptoms. Look inside to make your decision, and dont ever be afraid to ask questions!

1 Hodis, H. 2008. Assessing benefits and risks of hormone therapy in 2008: New evidence, especially with regard to the heart. Cleve. Clin. J. Med., 75 , S3S12. URL: .

2 Encyclopedia URL: pid=10& gid=000091 .

3 Hofling, M., et al. 2007. Testosterone inhibits estrogen/progestogen-induced breast cell proliferation in postmenopausal women. Menopause, 14 , 183190. URL : .

See also:

Ness, R., et al. 2009. Influence of estrogen plus testosterone supplementation on breast cancer. Arch. Intern. Med., 169 , 4146. URL: .

6 Espeland, M., et al. 2004. Conjugated equine estrogens and global cognitive function in postmenopausal women: Womens Health Initiative Memory Study. JAMA, 291 , 29592968. URL: .

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Coronary Heart Disease Findings

The coronary findings in WHI for the E+P trial were of borderline significance 1.24 . Furthermore, the reported data varied over several publications . However, there was some evidence for early harm among the older women in the E+P trial, as had been suggested earlier in the Heart and Estrogen/Progestin Replacement Study , but no increase in younger women. Indeed, the point estimates in the younger group showed a trend to benefit. In women receiving E+P< 10 years from menopause, the hazard ratio was 0.89, and it was > 1 in the older age groups. In the estrogen-alone trial in hysterectomized women, there was clearly benefit in using a composite coronary score: 0.66 . In WHI and in a recent case-control study, coronary calcium scores were significantly reduced in women on estrogen . A meta-analysis of women receiving HT who were under 60 years old, including data from WHI, showed a statistically significant reduction in coronary disease .

In a WHI publication that combined data from the HT groups stratified by recency of menopause, women < 10 years from menopause had a hazard ratio for CHD of 0.76 , with a significant trend for worsening with time since menopause in the other groups . There was also a 30% reduction in all-cause mortality as discussed earlier: 0.70 . A 10-year follow-up of women in the estrogen-alone trial in WHI showed that the 50- to 59-year-old group had a significantly reduced risk of MI and CHD . In this study, total mortality was also reduced 0.73 .

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