Estrogen Replacement Risks

Postmenopausal women taking a common hormone-replacement regimen that includes estrogen and progestin may be at increased risk of heart disease and breast cancer, according to a new study in the Journal of the American Medical Association (2002;288:321–33). This is disturbing news for the millions of women who have been prescribed hormones to prevent heart disease and osteoporosis or to treat menopausal symptoms. Researchers discontinued the study early, since they felt the risks of estrogen and progestin therapy significantly outweighed the benefits.

The use of long-term hormone replacement has become controversial over the past few years, particularly due to increases in breast cancer and lack of protection against heart disease reported in other studies. With the publication of the new study, there is now strong evidence that long-term use of the conventional Premarin®/Provera® regimen causes more harm than good.

Some physicians believe that the adverse effects seen in studies of hormone-replacement therapy are the result of using hormones that are structurally different from a woman’s natural hormones. Most studies have used estrogens obtained from the urine of pregnant horses (Premarin®) combined with a synthetic version of the natural hormone progesterone (medroxyprogesterone acetate; Provera®). Although there are anecdotal reports that using hormones identical to those produced by the human ovary (estrone/estradiol/estriol plus natural progesterone) is effective and safer than Premarin®/Provera®, no scientific studies have been done to confirm those reports.

The Women’s Health Initiative was a study designed to evaluate the benefits and risks of 0.625 mg of conjugated equine estrogens and 2.5 mg of medroxyprogesterone acetate per day in almost 17,000 healthy women between the ages of 50 and 79. The study was supposed to continue for eight and a half years but was terminated after five years due to significant increases in the incidence of breast cancer, heart disease, blood clots, and strokes in women taking the hormones compared with those taking a placebo. Although reductions in the incidence colon cancer and hip fractures were also observed in the women taking hormone replacement, the researchers decided these benefits did not justify continuing the study.

Women seeking treatment for menopausal symptoms, and those interested in preventing heart disease and osteoporosis, may benefit from some nutritional or herbal therapies. Several studies suggest that consuming 50 to 60 grams per day of soy protein or taking a supplement containing 50 to 100 mg per day of soy isoflavones may reduce the risk of heart disease, decrease hot flashes, and prevent osteoporosis. Taking 2 to 8 mg per day of a standardized extract of black cohosh (Cimicifuga racemosa) may reduce hot flashes and other menopausal symptoms, but has no known effect on preventing osteoporosis. Some studies suggest 300 to 600 mg per day of magnesium may help prevent osteoporosis. Some people develop loose stools from magnesium supplements, a side effect that can usually be eliminated by reducing the amount taken. For more information on other natural treatments or for specific amounts to take, it is best to consult a physician knowledgeable in nutritional or botanical medicine.

Darin Ingels, ND, MT (ASCP), received his bachelor’s degree from Purdue University and his Doctorate of Naturopathic Medicine from Bastyr University in Kenmore, WA. Dr. Ingels is the author of The Natural Pharmacist: Lowering Cholesterol (Prima, 1999) and Natural Treatments for High Cholesterol (Prima, 2000). He currently is in private practice at New England Family Health Associates located in Southport, CT, where he specializes in environmental medicine and allergies. Dr. Ingels is a regular contributor to Healthnotes and Healthnotes Newswire.

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