Hormone Replacement Therapy

Menopause, a time of change for women has been referred to as a transition to a new sense of freedom.

But with this freedom comes a great deal of uncertainty - uncertainty about the best way to deal with the subsequent changes, and menopausal symptoms, such as hot flashes, night sweats, calcium deficiency, insomnia and irritability.

To help alleviate such symptoms, there are both traditional and alternative approaches.

“Hormone replacement therapy is basically the use of naturally derived hormones to prevent and treat menopause symptoms, and to prevent and protect against degenerative diseases associated with menopause.” explains Dr. Kim Wilmot, a partner in Calgary’s Centre for Preventive Medicine.

Wilmot is a member of the American College for Advancement of Medicine (ACAM), a group of 1,500 doctors who assemble twice a year for 50 hours to discuss integrated medicine - the type of medicine where patients essentially design their own care.

“Many people are looking for alternative health care, and conventional medicine is not perfect,” Wilmot says. “We’re looking at blending alternative and conventional medicine to provide the best care for their patients.”

Menopause is not a problem for all women, and not all women experience the same symptoms.

“Some women transcend menopause very well.” Wilmot says Asian women, for example, with a primarily vegetarian diet high in soy products, appear to have fewer symptoms of menopause. They are also at less risk with regard to breast cancer.

Menopause, which generally occurs in women between 42 and 58 years of age, signals the end of naturally produced estrogen - and with this end of production, comes concerns.

There are four degenerative diseases that can become exacerbated by the lack of naturally produced estrogen: osteoporosis, heart disease, colon cancer and dementia. Women with a family history of such degenerative diseases, in consultation with a doctor, may be encouraged to seek some form of hormone replacement therapy (HRT).

For more than 50 years, the most commonly prescribed and widely recognized HRT has been a combination of estrogen, 0.625 mg Premarin, together with a complementary dose of progesterone. Premarin is an acronym of its source, pregnant mare urine.

The Premarin and progesterone are given together to prevent the Premarin from causing tissue build up in the uterus. “But the current thinking is that taking Premarin longer than five years increases the risk of breast cancer,” Wilmot says.

However, this is not to lessen the benefits for some women do derive from taking Premarin. for others, though, several side-effects could be associated with Premarin such as bloating, headaches, nausea and breakthrough menstrual bleeding. and for these very reasons, Wilmot says many women who have been prescribed Premarin, simply quit.

“But, a lot of women who should be taking some kind of hormone replacement therapy, aren’t” Wilmot says. “compliance will decrease with anybody who is having these side-effects.” Medical advice should be sought before starting or quitting, hormone replacement of any type.

An alternative to estrogen from a mammalian source could be a plant-based natural hormone therapy, also known as Triple Estrogen (Tri-Est) therapy. Natural hormones, or phytohormones, are most commonly derived from foods such as soybeans and wild yams. And, as these are plant-based hormones, the body may be better able to utilize them.

“Hormones from wild yams are (more) similar to a woman’s naturally circulating hormones,” Wilmot says. Not all pharmacies are equipped to compound the natural estrogen supplement from a base of wild yam or soy. TriEst is available by prescription only from four Calgary area pharmacies.

“The main difference between Tri-Est and Premarin is in the ratio of estrogens,” Wilmot says. Premarin has 70% estrone, 8-18 percent estradiol, and no estriol. Estriol is the most abundant estrogen normally found in women and according to Wilmot, the most important.

In Tri-Est, the estrogen ratio more closely resembles that which is considered normal - 10-20 per cent estrone, 10-20 percent estradiol and 80 per cent estriol.

In conjunction with Tri-Est, a natural progesterone cream, or plant based progesterone, such as Prometrium, may be preferable to a synthetic progesterone.

“Natural progesterones tend to have less side effects than the synthetics, such as Provera” Wilmot says and adds, “natural progesterone is more beneficial to lipids, (cholesterol) and bone health than Provera.

Other alternative methods of dealing with, or lessening the severity of symptoms related to menopause include aromatherapy, food therapy, herbal therapy, juice therapy and reflexology. Keep in mind these natural therapies should be practiced in conjunction with medical care and a doctor’s approval.

“Emphasis on lifestyle, diet, and exercise is extremely important,” Wilmot says. “The more natural we can keep our bodies, the better off we are.”

Several books on the subject of menopause are available, and one recommended by Wilmot is Women’s Bodies, Women’s Wisdom by another ACAM member, Dr. Christiane Northrup.

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“Emphasis on lifestyle, diet, and exercise is extremely important,” Wilmot says. “The more natural we can keep our bodies, the better off we are.”

Several books on the subject of menopause are available, and one recommended by Wilmot is Women’s Bodies, Women’s Wisdom by another ACAM member, Dr. Christiane Northrup.