New Era for HRT and Women's Health
by Deborah Moskowitz, ND

Still in a quandary over hormone replacement therapy (HRT)? Many women, upon learning of the discontinuation of the estrogen/progestin findings of the Women's Health Initiative Study (WHI) in June 2002 were in a state of confusion over what to do. To be honest, a fair number of their doctors were as well. What the study demonstrated was that the most popular type of HRT (PremPro) increased the risk of several conditions, including breast cancer, heart disease and dementia. Prior to this conclusion, women and their physicians were under the impression that this therapy was safe and effective, helping prevent some of these conditions.

It propelled doctors to look at women as individuals, with unique needs, risk profiles and concerns. What we now know about HRT is that one pill doesn't fit all, and we shouldn't necessarily expect it to. Perhaps more than any other single event in the last decade, the WHI study promoted an exploration of other routes women and their physicians have taken to meet women's health needs at midlife. Many physicians are favoring the use of human-identical hormones (estradiol, estrone, estriol, progesterone) over the synthetic or otherwise non-human hormones utilized in the WHI study (conjugated equine estrogens, medroxyprogesterone acetate). This trend began over 25 years ago, but has just begun to hit mainstream within the last decade.

Also significant is the evaluation of different dosages and routes of application. Many pharmaceutical companies have since released "low dose" options as well as other dosage forms, like patches, gels, suppositories, and more. Although more research is needed to fully compare the risks and benefits of each dose and application model, the FDA recently came out with recommendations that women use the minimum amount of hormones to achieve the desired benefits. One of the most popular choices women make in natural food stores is for progesterone cream. Clinical studies on one brand containing 20 mg per application, demonstrated benefit in the trial participants with respect to hot flashes, the most common complaint women experience at menopause. Women in the study applied 1/4 tsp of cream to their inner arms, inner thighs, or abdomen twice daily for three weeks out of each month and saw improvement in both the number and severity of their hot flashes over an eight-week period.

Herbal medicine has been used for centuries to support women's health and hormone balance. Two herbs that are continuing to be utilized and are the focus of recent research in both the USA and abroad are red clover (Trifolium pratense) and black cohosh (Cimicifuga racemosa). The National Institute of Health is currently sponsoring a study on the efficacy of black cohosh and red clover for the relief of menopausal symptoms.

Soy has been a recent focus of attention for researchers and health practitioners as it is high in phytoestrogens, compounds that can weakly mimic estrogen in our bodies. Functioning as a phytoestrogen, soy acts in the body by binding to estrogen receptor sites and exerting weak estrogen-like effects and helping with the conversion of strong estrogens to less active forms, rather than having a direct effect on the production of estrogen or other hormones.

There are a number of recent studies that look at the effects of soy isoflavones on hormone levels in both premenopausal and postmenopausal women. Results have not been consistent, with some studies showing hormonal effects and others no effect. With respect to menopausal symptoms, four recent studies have shown significant benefit of soy supplementation for the relief of menopausal hot flashes. Two of these four studies also showed that the soy supplement had no effect on the uterine lining like estrogens do. In addition to the benefits of soy for menopausal hot flashes, the medical literature is revealing other positive health benefits for women including lowering cholesterol levels and blood pressure.

Exercising is the number one prescription for health that positively impacts a myriad of conditions and symptoms, including those seen at menopause. Exercising a half hour three times a week has been shown in various research studies to reduce hot flashes, improve cardiovascular health and reduce breast cancer risk. It also reduces stress. All it takes is a commitment to make it a part of your life. Understand that there are many paths to wellness. Through education and exploration, most women will be able to find the path that is right for them.

Dr. Deborah Moskowitz, N.D., is an author, lecturer and Director of The Emerita Women's Institute, a division of Transitions for Health, Inc., Portland, OR. She also maintains a private practice with a focus on women's health and sports medicine. Dr. Moskowitz earned a bachelor's degree from Vassar College, a Doctor of Naturopathy degree from the National College of Naturopathic Medicine and further studied at the Oregon College of Oriental Medicine.