Many women understandably worry more about their hormone replacement therapy
since the recent report about PremPro (Premarin and Provera).
Simply stated, the risk to life seemed to outweigh the chances of prolonging
life when women were all given the same dose of PremPro.
A few things to note about the study are:
- 40% of the women stopped the drug before the study was over. In some
studies up to 50% drop their hormone replacement therapy (hrt) within the
first year. Clearly, there is something to be learned about how to
make hrt more tolerable.
- All of the women took the same dosage. I don't know another
medication with the potential dangers of estrogen where blood levels are not
followed (when available). With thyroid medication, we do not give
everyone the same dosage. Even with several different dosage forms of
thyroid, even more elaborate dosing patterns are frequently used to obtain a
blood level that is high enough to do the job and not so high to cause
danger (therapeutic range). I contacted the researchers and no
estrogen levels are being reported yet. Blood levels will be
measured but the data is not available yet.
- The increased incidence of heart disease, stroke, and pulmonary embolus
was not correlated to weight. I don't think you would see this
increased risk in these three events if the estrogen/progesterone
combination was not given to the very obese. Again, this data is not
available yet but it could be that you do not see this increase in these
diseases in those who practice a healthy lifestyle.
- This study used estrogen that is taken from a mare's urine (Premarin) and
synthetic prgesterone (Provera). We do not know yet know but have good
evidence that estrogen and progesterone natural to a woman's body (available
from compounding pharmacies) might not be as dangerous. Some studies
of estriol (another form of estrogen--Premarin is estradiol)
even seemed to show that the hormone protects a woman from breast cancer.
- If you want to read
some of the study results for yourself and the opinion of the
researchers you can go to the following sites:
- The actual JAMA
- The approach I recommend is as follows: 1. Use mostly
estriol to replace estrogen 2. follow blood levels
and keep them low 3. practice a healthy lifestyle 4.
Use hormones natural to a woman's body and not what's natural to a
horse. 5. Pay attention to and balance not only
progesterone and estrogen but also testosterone, and both free T3 and free
T4 (thyroid hormones), and DHEA.