How Safe Is “Natural” Hormone Replacement Therapy?

The quick and dirty answer to this question is: it’s not safe at all. In fact, no hormone replacement therapy is safe, yet, numerous pre-menopausal, menopausal, and post-menopausal women participate in such therapies regularly. Actually, so do many men; although, it’s far more common for women.
 
In the Women’s Health Initiative Study, a 15-year project performed in the 1990s studying nearly 70,000 post-menopausal women ages 50-79, discovered numerous health effects of hormone replacement therapy (HRT). The therapy used the FDA approved traditional hormone replacement drugs, not “natural” therapies. The study showed significant increases in the risk of breast cancer, coronary heart disease, stroke and venous thromboembolism (i.e. blood clotting).

Research from this study showed that older women who have long been through menopause – regardless of their initial health – were at risk for these serious health issues.

Hormone replacement therapy was originally touted to help women with menopausal symptoms such as weight gain, bloating, hot flashes, night sweats, and similar issues. While that is true and HRT did relieve those symptoms, the Women’s Health Initiative discovered the health risks far outweighed the benefits these benefits.

That brings us to what has been marketed as a safer alternative to synthetic hormone replacement therapies. Known by several different names – bioidentical hormones or natural hormones – this therapy is not necessarily safer.

Bioidentical Hormone Replacement Therapy (BHRT) is controversial because of the mistaken belief that the hormones are personalized to the individual’s body make-up. That’s not necessarily true; and considering how recent these products were introduced, there are few studies on them. Individualization of hormone therapy has made “natural” therapies popular, but not necessarily safer.

A clinical review of BHRT published in 2011 in the Journal of the American Board of Family Medicine provided several specific discussion points for health practitioners in regard to these bioidentical hormones. Here are four critical points to consider:

1. Bioidentical hormones are not necessarily “natural.” Natural refers to the source of the hormones. Natural and bioidentical hormones both come from the same source of soy and plants but bioidentical hormones must be commercially processed.

2. The Food and Drug Administration has approved some bioidentical hormones, but custom compounded hormones are not subject to federal law. These custom hormones contain so many combinations that it would be difficult to monitor and test. Plus, custom compounded hormones will vary from batch to batch causing variations in the doses received and benefits earned.

3. There is no safe hormone therapy. All active ingredients are the same regardless of whether they are synthetic, bioidentical or custom compounded; therefore, the risks are the same. There is no such thing as a safe hormone therapy.

4. It is nearly impossible to accurately monitor hormone levels in those receiving individualized hormone therapy. Every woman is unique in how she processes hormones within her body, therefore, routine blood tests or salivary tests do not necessarily show adequate or accurate results. As an example, even the smallest of elements such as brushing your teeth can affect salivary test results. The journal noted that positive tracking is typically based upon symptom relief not laboratory results.

 

Some positive news can be said about hormone replacement therapies. Evidence from a 2008 study of conventional hormone replacement therapies in younger, menopausal women showed that the benefits did outweigh the risks when the therapy was used short-term. The study was performed in people younger than age 60 who had either been in pre-menopause or menopause.

The point here is that hormone replacement therapies – natural or conventional – can be effective if the individual is young, healthy, active and going through the menopausal process. After a certain point (i.e. post menopause), hormone replacement should be eliminated. If you are interested in hormone replacement therapies, you are encouraged to talk with your physician.

 

Works Used for this Post: 

Bosarge, P. M. and Freeman, S. (2009). Bioidentical hormones, compounding and evidence-based medicine: What women’s health practitioners need to know. The Journal for Nurse Practitioners, 5(6), 421-427.

Kuehn, B. M. (2008). FDA warns claims for pharmacy-made “bio-identical” hormones are misleading. Journal of the American Medical Association, 299(5), 512.

Sood, R., Shuster, L., Smith, R., Vincent, A., and Jatoi, A. (2011). Counseling postmenopausal women about bioidentical hormones: 10 discussion points for practicing physicians. Journal of the American Board of Family Medicine, 24(2), 202-210.

Women’s Health Initiative. (2014). WHI Overview. Retrieved from https://www.whi.org/about/SitePages/About%20WHI.aspx

 

 

Occupational Hazard: Sitting increases your risk of cancer

If you’re female, you might want to consider a more physically active career to avoid a variety of cancers.
 
A meta-analysis of thousands of Europeans across seven different groups (five in England and two in Scotland) found that sitting occupations were linked to a greater risk of cancer mortality – but for women only, not for men. Another study in the Netherlands included nearly 130,000 people drew the same conclusion.

It is unclear how sitting can be linked to a greater risk for cancer, especially colon cancer. Yet, studies have suggested that sitting occupations may reduce lipoprotein lipase activity by up to 90% and significantly slow insulin action. Lipoprotein lipase (LPL) is a gene that is responsible for producing an enzyme that plays a critical role in transporting and breaking down fats which then is used for energy or stored. Retarded insulin secretion can lessen the effects of metabolism. Both actions have been linked to obesity and related diseases.

Furthermore, sedentary behaviors and cancer may also involve adiposity (the state of being fat), inflammation (swelling), and sex-hormone related pathways (efficient use of estrogen, testosterone, and progesterone). All of these elements can cause obesity and related health issues – including cancer.

It comes down to the same theme we’re all heard over and over: get moving to prevent illness and disease.

 If you work in a sitting occupation, consider adding the following to your daily routine as suggested by the Workplace Health and Safety sector of the Attorney General’s office in Queensland (Australia):

1. Use a height adjustable desk so that you can work standing or sitting

2. Move your printer, scanner and other office equipment so that you have to walk to them to use them

3. Standing during phone calls

4. Walk to your colleagues’ desks; don’t phone or email them

5. Hold standing or walking meetings

6. Eat lunch or snacks away from your desk

7. Take breaks regularly to stand, stretch or walk for a few minutes

8. Use the stairs, not the elevator

9. Walk during your lunchtime or breaks

10. Walk or bicycle to work, or park further away from the office and walk the rest of the way

 

Regardless of what you do, the point is to move more. It can reduce your risk of cancer.

 

Of interest, it is unclear why women who sit for their jobs are at a higher risk for cancers than men. It has been suggested that men who work in sedentary occupations are more likely to participate in physical activity outside the office than are women. There have been studies that suggest women who begin exercising before puberty can reduce their risk of cancers even if they end up with a sedentary occupation.

Research is very clear about one thing: physical activity in your daily routine can prevent diseases and keep you healthy.

 

Research used for this article:

Schonfeld, S. J., Neta, G., Sturgis, E. M., Pfeiffer, R. M., Hutchinson, A. A., Xu, L., Wheeler, W., Guenel, P., Rajaraman, P., de Bathaire, F., Ron, E., Tucker, M. A., Chanock, S. J., Siqurdson, A. J., and Brenner, A. V. (2012). Common genetic variants in sex hormone pathway genes and papillary thyroid cancer risk. Thyroid, 22(2), 151-156.

Simons, C., Hughes, L., van Engeland, M., Goldbohm, A., van den Brandt, P., and Weijenberg, M. (2013). Physical activity, occupational sitting time, and colorectal cancer risk in the Netherlands cohort study. American Journal of Epidemiology, 177(6), 514-530.

Stamatakis, E., Chau, J., Pedisic, Z., Bauman, A., Macniven, R., Coombs, N., and Hamer, M. (2013). Are sitting occupations associated with increased all-cause, cancer, and cardiovascular disease mortality risk? A pooled analysis of seven British population cohorts. PLoS One, 8(9), 1-10.

Workplace Health and Safety Queensland. (n.d.). Sedentary work – sit less and move more in your work day. Retrieved from http://www.justice.qld.gov.au/__data/assets/pdf_file/0006/160089/sedentary-work-factsheet-ekka.pdf.