FEMALE HORMONE REPLACEMENT

HRT the smart choice for post menopausal women
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HRT the smart choice for post menopausal women
10 reasons for HRT
Estrogen lowers breast cancer death rate
Breast Cancer Survival up with subsequent HRT
Estrogens provents hardening of the arteries thus cardiovascular disease
Setting the record straight with journal articles on HRT
HRT for Postmenopausal Women, and PhARMA Profits First
More Setting the Record Straight
HRT Studies, much fewer heart attacks, etc.
Breast-Firmer-HRT
Cholesterol profile improved by Estradiol
Cognitive functions improved
Increased libido (sex drive)
More More setting the record right
healther skin with HRT
Bioidentical Hormone therapy advice
HRT benefits journals
Choice of progestagen component in HRT affects incidence of Breast cancer
HRT & Heart Benefits--etc.
22% muscle loss prevented with testosterone
Arthritis effective treatment HRT
Testosterone, Sex Drive, Feeling Better, etc--Mayo Clinic
Testosterone improves sexual desire and sex
FDA Article on Menopause and HRT
Bioidentical Hormone therapy advice
Prempro settlement $330M
alcohol and higher estradiol and testosterone levels in postmenopausal women

Natural HRT Benefits vs. Mare’s Urine Estrogen with MPA--the tragic differences (12/9/13)--jk

 The reason why women’s health precipitously declines after menopause http://healthfully.org/rc/id2.html   

The long-term use of NATURAL estradiol (estrogen) and progesterone has been shown to DECREASE the risk of:  Alzheimer’s 83%, Heart attacks 32%, Coronary Heart Disease 50%, Colorectal Cancer 46%, Breast Cancer 73%, Thrombosis 8%, Osteoporosis Fractures 90%, Macular degeneration 65%, reduces & prevents arthritic join destruction, firmer breasts, Healthier skin (less wrinkles, thicker, 48% more collagen), reduces hair loss, improves cognitive function, less depression and mental illness, and a general feeling of well-being with increased libido. These claims are referenced below and at http://healthfully.org/fhr/.

WARNING: Avoid E3 &, E4; they are E2 antagonist (block action of the good estrogen).  Pharma has doctors prescribe it in with E2 for HRT.   

Backdrop:  1) The Pharmaceutical industry (pharma) is about profit maximization; public service is their hype.  2) What follows assumes that you have read the 2-page account of the state of Marketing Science and Misinformation”.  You will find out how big pharma totally dominates medicine; namely through research & publication, the production of information for physicians and public, the setting up of treatment protocols (guidelines), and the FDA from the top- down.  Money talks:  the medical journals and media are “pharma friendly”, as is our 2-party system.

Estrogen Basics:  Estrogens (Wikipedia) are a group of related compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones.  Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal. The name comes from the Greek οἶστρος (oistros), literally meaning "gadfly" but figuratively sexual passion or desire,[1] and the suffix -gen, meaning "producer of".  Estrogens are synthesized in all vertebrates[2] as well as some insects.[3]  Like all steroid hormones, estrogens readily diffuse across the cell membrane. Once inside the cell, they bind to and activate estrogen receptors which in turn modulate the expression of many genes.[4] Additionally, estrogens have been shown to activate a G protein-coupled receptor, GPR30.[5]   The three major naturally occurring estrogens in women are (E1) estrone, (E2) estradiol, and (E3) estriol.  Estradiol (E2) is the predominant estrogen during reproductive years both in terms of absolute serum levels as well as in terms of estrogenic activity. Estradiol is about 10 times as potent as estrone and about 80 times as potent as estriol in its estrogenic effect.  Estrone is secreted by the ovary, adipose [fat] tissue, and placenta.  As a sulfate it acts as a reservoir that can be converted as needed to estradiol.  During menopause, estrone is the predominant circulating estrogen; while Estriol is during pregnancy in terms of serum levels.   Though estriol is the most plentiful of the three estrogens, it is also the weakest.  Thus, estradiol is the most important estrogen in non-pregnant females who are between the menarche and menopause stages of life.   A 4th type of estrogen called estetrol (E4) is produced only during pregnancy.  All of the different forms of estrogen are synthesized from androgens, specifically testosterone and androstenedione, by the enzyme aromatase.  Follicle-stimulating hormone (FSH) stimulates the ovarian production of estrogens by the granulosa cells of the ovarian follicles and corpora lutea.  Some estrogens are also produced in smaller amounts by other tissues such as the liver, adrenal glands, and the breasts.   Androstenedione has weak androgenic activity [muscle building] and is the predominant precursor for the more potent androgens such as testosterone as well as estrogen.   Among estrogen’s over 2-dozen bodily functions are those of lowering the remodeling threshold, thus preventing osteoporosis.  Estrogen prevents cardiovascular disease by lowering cholesterol levels, and by reducing inflammation and oxidative damage to LDL [bad cholesterol].  Inflammation and oxidative damage are causal factors for cognitive decline, Alzheimer’s disease and other conditions.  Estrogens circulate in the blood in association with proteins including sex hormone binding globulin and albumin (50-80%), and a significant portion is in the form of a sulfate.  It is distributed in most tissues, especially the breast, uterine, vaginal, and has a high affinity to adipose tissue.  Estrogens are metabolized in the liver and excreted as metabolites by the kidney.  Estradiol during menopause sharply declines; but the levels of total and free testosterone, as well as dehydroepiandrosterone sulfate (DHEAS) and androstenedione appear to decline gradually with age. The limited effectiveness of plant type estrogens is due to their lower bio-activity and first-pass metabolism by the liver.  Progesterone belongs to a class of hormones called progestogens, and is the major naturally occurring human progestogen. The recognition of progesterone's ability to suppress ovulation during pregnancy spawned a search for a similar hormone that could bypass the problems associated with administering progesterone (low bioavailability when administered orally, except in oil).  A progestin is a synthetic[1] progestogen that has progestational effects similar to progesterone.[2] The two most common uses of progestins are for hormonal contraception (either alone or with an estrogen), and to prevent endometrial hyperplasia [excess tissue in the uterus] from unopposed estrogen in hormone replacement therapy.  In mammals, progesterone, like all other steroid hormones, is synthesized from pregnenolone, which in turn is derived from cholesterol  in a very complex bio-system (Wikipedia).  Synthetic plant and horse estrogens are inferior to evolved human hormones.  The synthetics progestin MPA in Prempro inhibits most of estrogen’s positive effects.  As for other synthetic progestins, several increase cancer risk, and others lack literature including other side effects.  What follows are 3 sections:  setting the record straight by comparing natural HRT to Prempro; then a list of HRT’s benefits supported by links to articles; last are recommendations.     

^^^^^^^ Setting the record straight Prempro & natural HRT --  for more  http://healthfully.org/fhr/  ^^^^^^^ Bad Press:  Prempro, one of the first HRTs[1], has been marketed since 1942 by Wyeth Laboratory (bought out by Pfizer in 2009).  It has been and still is the best-selling HRT.   A supposedly definitive study of HRT was done by the FDA’s drug research branch, National Institute of Health (NIH) (with undoubtedly a nod from pharma).  The Women’s Health Initiative (WHI) knowingly selected the worst formulation of HRT, Prempro.  NIH had the results of the Hormone Estrogen Replacement Study (HERS ) completed in 1998  which used Prempro; moreover, the medical literature had numerous disappointing results for Prempro when compared to natural HRT formulas.  Prempro consists of an estrogen cocktail derived from pregnant mare’s urine to which is added the synthetic progestin MPA (medroxyprogesterone).  (The tragic treatment and slaughter produced from collecting urine for estrogen was broadcast by Frontline.)   “Pregnant mare’s estrogens are the weak estrone (>50%), and the two mare estrogens, equilin (15-25%) and equilenin….  Mare (equine) estrogens such as equilin, that are foreign to the human body, have been shown, when compared to other studies, to have effects that are significantly worse than the natural estradiol[2].” MPA, the synthetic progestin used in Prempro, blocks most of the beneficial effects of estrogen--the natural progesterone doesn’t.  Using Prempro, the WHI found that compared to a placebo there was increased incidents:  heart attacks 29%, breast cancer 26%, pulmonary embolism 113%, strokes 41%, total deaths 15%, all cancers 3%; reduced incidents: hip fractures 34%  and colon cancer 37%.”   (Compare this to the benefits of using the natural estradiol with progesterone listed at the top of the first page.)  The press made the most of the WHI results (undoubtedly with a nod from their biggest advertiser[3]). HRT sales plummeted with this assault.  The equine estrogen only arm of WHI had better results; more proof that adding MPA causes the harm.    Pfizer in 2010 settled a suit over breast cancer for $330 million or $150,000 per person.  Yet Prempro is still on the market (thank you FDA) and still first in sales.  Based on the WHI, NIH issued this warning: “…increased risk of myocardial infraction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women… Estrogens with or without progestins should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals…”  The warning is placed on all packages of HRT, and it is accepted as correct by most doctors.  My doubts about were confirmed when attending a lecture on the WHI given in 2002 at UCSD by Professor Dr. Robert Langer.  He explained to a large medical audience that the WHI results cannot be validly applied to other HRT formulas.  Over 50 years of research was not overturned; rather physicians and the public were tragically misled by the press, pharma, and the NIH. 



[1] First was DES (diethylstilbestrol) a non-steroidal estrogen developed in 1938.  Like Fleming with penicillin, DES was not patented because Dodds felt that scientists were working for the pubic, and it was too important to deny cheap availability  by patenting.  Animal studies had in the 1930’s exposed DES serious side effects; but the industry relied upon human trials, and the FDA on Sept. 19, 1942 approved DES though aware of the more reliable animal studies.  DES was marketed under 200 brand names.   Numerous claims were made such as producing healthier babies and preventing miscarriages.   In 1971 DES was found to cause a 40 fold increase in cervical & vagninal cancers.  Later studies found several internal genetal abnormalities in the daughters and sons of mothers given DES.  26 years later In 1997 Eli Lilly stopped making and  marketing DES.   DES is another example of an unnatural product having health consequences hidden for decade--like Prempro--mainly because of it is not in PhARMA’s financial interest to uncover and publish side effects.   DES was also the standard treatment for advance prostate cancer for over 40 years. 

[2] Equilin blocks E1 and E2 receptors and thus would like reduce the effectiveness of natural estrogens.  Though Prempro and Premarin (just equine estrogen) are still the world’s leading HRT and ERT, no follow-up research was done on this evidence for financial reasons by Wythe Labs.  

[3] Huge profits were made by PhARMA by their assault on HRT, because the incidents of chronic illnesses increased.  The sales of drugs to treat osteoporosis, heart attacks, depression, and Alzheimer’s disease all dramatically increased over the last decade.

BENEFITS   Cardiovascular disease (CVD) & MI: “estrogen lowered by 20% cholesterol, 37% LDL and raised by 14% HDL, extends life 2.1 years,” Braunwald, Heart Disease …, 5th Ed, 1997, p 1708.  “HRT decreases CAD morbidity and CAD mortality … was 0.56 compared to subjects not taking estrogen” [a 44% reduction] Braunwald 1142; another 50% reduction in CHD.  Estradiol blocks oxidation of LDL to prevent atherosclerosis.  Estradiol completely reverses the effects induced by OX-LDL on the DDAH/ADMA/NO pathway,” Avoid MPA and LNG (levonorgestrel).   Another study found 26 deaths for estradiol vs. 56 for placebo, -115%.  A meta-study found and a 50% reduction of Coronary Heart Disease.  Lowers rate of calcification of arteries which causes hypertension.  AHA study explains mechanisms of cardio protection arteries from damage, also,   Angina pain is associated with low estrogen, treated.

Decreases breast cancer 73% using estradiol:   “in breast cancer (10 in treated group v 17 in control group).”   HRT after & also during breast cancer greatly increases survival, also ratio 0.28--results would be better with progesterone. “MPA (Prempro) increases the risk of breast cancer” other progestins increase risk.  Contrary to PhARMA estradiol  progesterone doesn’t  increase risk,  and when given following breast cancer over  2/3rd fewer deaths at 15 years HRT, and  also, also, same for uterine cancer.     

Colon cancer: the reduction among current users RR = 0.55… users of 11 years or more RR of 0.54 [46% lower, also].” Estrogen and progesterone have beneficial effects for “esophagus, stomach, gallbladder, and intestines.” 

Alzheimer’s disease reduced 83% with  long-term HRT.  This is because estrogen is neuro-protective, it inhibits oxidative damage.  Progesterone also limits damage; thus it is used in large doses following trauma “to limit central nervous system damage.”

Venus Thrombosis:  an 8% reduction in risk of with Esterfied Estrogen while those on Prempro had a 65% elevated risk JAMA 04,  Cases and controls, , 23% reduction exogenous estrogen (5.1% of cases versus 6.3% of controls

Breast density measured for women on HRT.  The difference has been repeatedly noted on mammograms. 

Healthier skin American Journal of Clinical Dermatology & more hair, hair, hair.    Studies of postmenopausal women indicate that estrogen deprivation  is associated with dryness, atrophy, fine wrinkling, poor healing, epidermal thinning, declining dermal collagen content, diminished skin moisture.  The decrease was preventable by the use of HRT.” The mean collagen content in the skin was found to be 48% greater.   Conclusions: HRT significantly slows skin ageing.

 

Osteoporosis: Esterified estrogens produced significant increases in bone mineral density (lumbar spine, hip).   54.2% greater spinal mineral.  1 of 4 white women over the age of 60 had spinal compression fractures associated with osteoporosis.  One woman of 5 will fracture a hip by the age of 90”   Bone gain from long-term HRT, also; estradiol's role. 

Rheumatoid Arthritis (RA):  “Transdermal HRT was well tolerated, increased well-being, reduced articular index and increased lumbar spine bone density over a one year period in postmenopausal women with RA.”

Osteoarthritis (OA): When both incident and progressive radiographic knee OA cases combined, “current ERT [estrogen only replacement therapy] use had a 60% decreased risk compared with never use”.    

Macular degeneration, age related. HRT resulted in a 36% reduction and other eye pathologies.   

Urinary Tract Infections Recurrent (UTI), also urinary urgency, urogenital & vaginal atrophy are associated with low estrogen in post-menopausal women.  A meta-analysis of 8 quality studies found the placebo group 2.5 times more likely to have a subsequent UTI. Topical administration most effective; however for vaginal atrophy estradiol tablets were clearly superior.

Sexual Satisfaction:HRT improves sexual function,  lubrication and pain domains”; better with estradiol & TTT, &.

Mood elevation and depression: Numerous molecular and clinical studies have implicated estrogen in modulating brain function including that related to mood,” and for treatment of mood disorders and depression.

10 Reasons for HRT:  Menopause Int. & Oncology:  Both list the above benefits, and the latter advices HRT for breast cancer patient survivor that they take HRT because of “a 70% reduction in the risk of death” during the 15 years: also.

     

Sarcopenia refers to the loss of skeletal muscle mass with age and is associated with low level of estrogen or testosterone.   Sarcopenia in 22.6% in older postmenopausal women not receiving estrogen or TTT.   TTT prevents and reverses sarcopenia, and.      

                                                                                                                                                                                                                   

RECOMMENDATIONS:   a dose comparable to the Danish study (sequential 2 mg estradiol with a progestin that simulates growth of breast cancer).  Thus USE natural progesterone 50 mg micronized in oil capsule with 2 mg estradiol prepared in a compounding pharmacy or a lotion 4-8 mg of estradiol + 100 mg progesterone because skin absorption is 10-15%.  Bio-activity decreases with age.  If concerned about strength add 10 mg testosterone to prevent sarcopenia, to reverse androgen deficiency, and improves libido.  In the 1980s testosterone was safely used in HRTs instead of a progestin.  Progesterone lowers risk of uterine cancer and has other benefits.  Apply widely as possible over the torso, back, shoulders, underarms, and face using water and rubbing it in to promote better absorption.   Avoid estriol (E3) and estetrol (E4) pregnancy estrogens; both block the estradiol (E2)—another market ploy by pharma.  Avoid progestins--see MPA above as example.  Beware of doctors who do hormone balancing; it is not based on science.  Evidence on superiority of sequential HRT has not been studied; but it has lower compliance because of vaginal (endometrium) bleeding.  Ideal free-serum estradiol level is 400 pg/mL.    JK since 2003 uses compounded testosterone lotion, increased in 2011 to 150mg/gm/1/4 tsp. applied as described above.    

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^  non-technical summation

Natural Estrogen (Estradiol) with progesterone HRT:  What every woman should be taking because of the numerous, major health benefits, benefits that would slash pharma’s profits.  Of the 4 natural estrogens only estradiol has major benefits.  Two--estriol (E3) and estetrol (E4)--are found in pregnant women.  These 2 inhibit the functions of estradiol.  Big pharma being against hormone replacement therapy (HRT) markets ineffective products including those containing estriol and estetrol, estradiol at too low a dose, and Prempro.  Based on marketing science, including a major study by the FDA which used Prempro, a combination of estrogen derived from pregnant mare’s urine and the progestin MPA.  The biological effects of mare’s estrogens are different than human estrogen and MPA blocks the some of the positive effects of estrogen.  Nevertheless, the FDA warns that HRT (hormone replacement therapy) has only one valid medical use, to manage hot flashes, and it should be used at the lowest dose for the shortest time.  But the finding for Prempro[1] cannot be validly generalized to the natural estradiol and progesterone—though pharma and the FDA do.  Thus marketing science overturned 4 decades of positive results that show significant health benefits for HRT:  Alzheimer’s 83%, Heart attacks 32%, Coronary Heart Disease 50%, Colorectal Cancer 46%, Breast Cancer 73%, Thrombosis 8%, Osteoporosis Fractures 90%, Macular Degeneration 65%, reduces & prevents arthritic join destruction, firmer breasts, healthier skin (less wrinkles, thicker, 48% more collagen), reduces hair loss, improved cognitive function, less depression and mental illness, and a general feeling of well-being with increased libido.  Estradiol is the only effective treatment to prevent osteoporosis, and its methods of cardiovascular protection are well documented.  The lack of estradiol is the reason for the precipitous decline in health of women.  Life extension with long-term HRT should be at least 4 years—though clinical trials do not address this.    Because of a modest increase in uterine cancer a progestin (synthetic hormone with some progesterone properties that is orally active) is added to hormone replacement therapy rather than the natural progesterone which isn’t orally active.  Progesterone--the major natural occurring progestogen--has numerous benefits, while some of the artificial progestins are clearly harmful, and none have been adequately researched as to side effects.  Thus like with testosterone which isn’t orally active, the best method of application is a lotion obtained from a compounding pharmacy in a dose of 4 mgs estradiol plus 100 mg of progesterone per application.  Apply widely as possible over the torso, back, shoulders, underarms, and face using water and rubbing it in to promote better absorption. Recently progesterone has been micronized in oil and available as a pill.  Ideal free-serum estradiol level is 7-9 pg/mL.  A compounding pharmacy can prepare a pill consisting of 2 mg of estradiol with 50 mg of progesterone (there is a 15% absorption rate with topical hormones, except for the patch).   The lotion form is better for the skin.  Plant sources of estrogen are not very effective.  Doctors who follow the Wiley Protocol are other methods of hormone balancing for post menopause women are milking the insurance and patient, and it lacks sound scientific evidence.  Keep it simple.     



[1]   Prempro has been the leading selling HRT since the mid 40s in the US, and it still is.  The issues with MPA and mare’s urine estrogen have been know for decades by scientist including those in the FDA, as too the superiority of the natural HRT.  Because of birth control pills, HRT, and the possibility that an estrogen would protect men—as it does women—from cardiovascular disease, there has been thousands of published articles on the estrogen and progesterone family of hormones. 

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