Why is there so much controversy and conflicting information surrounding hormone replacement therapy? The simple answer is that research on hormone replacement is limited and confusing. Women’s health issues, in general, do not attract research interest or funding. For example the recent discovery of the hormone that is responsible for morning sickness. Morning sickness can be a debilitating and disabling condition that can threaten the health and safety of the mother and her baby. And yet, we are just now discovering the possible cause largely due to a female physician who experienced her own severe morning sickness and decided to find the cause. Now, there is hope for a treatment.
Hormone replacement research is also on an uncertain path. Much of this is due to the years-long prevailing belief that hormone replacement wasn’t safe for women after the 2002 Women’s Health Initiative (WHI) study was abruptly halted. Researchers found that women taking a combination of estrogen and progestin had an increased risk of breast cancer, heart attacks, stroke, and blood clots.
However, that study has been debunked, and “an 18-year follow-up study of the participants in the WHI study provides more reassurance on the safety of hormones. The report found that women who took hormones did not have a greater chance of dying in the subsequent 18 years than those who did not.”
Despite the WHI study being disproved, many health providers continue to make hormone replacement therapy decisions based on that study’s findings. Meanwhile, there is not much interest in researching bio-identical hormones. Funding for clinical trials comes from various sources, including government, private investors, charities, universities, and other research institutions. However, the vast majority generally originates from the pharmaceutical company with the greatest financial stake in the completion of the trial.
The Problem with Research Studies
For concerned patients seeking reliable information, understanding research studies is almost impossible. Extrapolation and interpretation of studies hit major media outlets, and misinterpretation is common. Research design can be fraught with problems too numerous to mention, but here are a few:
The description of the design and/or method is so vague and unfocused as to prevent adequate evaluation of its worth. For example, most hormone replacement studies combine multiple types of therapies (patches, pills, synthetic, bio-identical, pellets, and injections) in determining outcomes.
The data the investigator wishes to use are either difficult to obtain or inappropriate for the research problem.
The proposed methods, measurement instruments, or procedures are inappropriate for the research problem.
Appropriate controls are either lacking or inadequate.
The equipment to be used is outdated or inappropriate.
The statistical analysis has not received adequate consideration, is too simplistic, or is unlikely to yield accurate and clear-cut methods.
Small sample size
One of the more notable flaws is a study that shows an “association,” which is then misinterpreted by the public to mean “causation.” Causation requires an association between two variables, but an association does not necessarily imply causation.
Bio-Identical Hormone Replacement vs. Synthetic
Every supplement and medication you take has risks. The trick is to evaluate the risk-to-benefit ratio, which we do with your input at Optimal Hormone Health. There is a significant difference between bio-identical hormone replacement and synthetic hormones relevant to this discussion and the research on safety. Whether bio-identical hormones are safer than synthetic ones is open to debate, and here is where the research is scant. Although the FDA has approved certain types of bio-identical hormones, the FDA's lack of oversight on compounded hormones creates a lack of confidence in the product.
Bio-identical hormones are modified to have the exact same molecular structure as the hormones produced by the human body. On the other hand, synthetic hormones are altered into drugs that are “similar” to human hormones but not identical to them. Most studies on the safety and efficacy of hormones are on synthetic hormones.
“Bioidentical hormones are manufactured hormones derived from plants, often soy and yams, that are chemically identical to those the human body produces. As such, they bind to the estrogen and testosterone receptors in the same way as women’s endogenous hormones have throughout their lives…..there is growing evidence in support of using individualized doses of testosterone for sexual function, osteoporosis prevention, and breast protection. The safety has been evaluated for the past 80 years.”
Another key difference is that synthetic hormones come in pre-made doses. On the other hand, bioidentical types of hormone replacement therapy doses are tailored to your body’s needs based on lab results and ongoing evaluation of hormone levels throughout your treatment.
How Long to Stay on Bio-Identical Hormone Replacement Therapy
Now, to the question at hand. A recent study has shown that hormone replacement after the age of 65 increases the risk of dementia. However, closer examination of these studies reveals the following flaws:
Synthetic hormones were used, not bio-identical.
There was an “association” between hormone use after 65 and dementia.
Part of the reason for the uncertainty is that many studies only show a connection between dementia and HRT, but they can’t tell us if HRT leads to dementia. Brain fog is a common symptom of menopause but may also be an early symptom of dementia. If early dementia symptoms are confused for menopausal symptoms, women who are more prone to dementia may be seeking hormone replacement.
More research needs to be conducted using bioidentical hormones.
At Optimal Hormone Health, after careful assessment of risk factors, long-term hormone use has many more benefits than risks.
Benefits of Long-term Hormone Therapy Treatment
Researchers suggest that lowered estrogen levels may be a factor in the possible connection between menopause and dementia. A lack of estrogen over the long term enhances oxidative stress, which may increase brain aging and lead to cognitive impairment. Other benefits of hormone replacement:
Bone Density. Osteoporosis is a significant health concern for older women. Bone density starts to deteriorate following menopause due to a decline in estrogen.
“Osteoporosis is a serious health issue among aging postmenopausal females, who are at an increased risk of fracture. Bone mass is increased in childhood, reaching a peak level by the woman’s third or fourth decade of life. After that, bone loss begins and accelerates at menopause. One study has reported that the rate of osteoporosis approximately doubled every 5 years, starting from the age of 45–49 at 3.3% and progressively increasing to 50.3% at the age of 85 years and older. The majority of postmenopausal females with osteoporosis have bone loss related to estrogen deficiency. The rapid bone loss results from an increase in bone turnover with an imbalance between bone resorption and bone formation.”
Mood. Mood and memory problems are associated with low estrogen during peri-menopause and menopause.
Energy and muscle mass. Testosterone replacement can improve energy levels and endurance and build muscle mass. Sarcopenia is the gradual loss of muscle mass that affects strength and function. Studies have shown up to a 2.32-fold increase in mortality for older adults who have Sarcopenia.
Improved libido and less painful sex. Post-menopausal women often report a loss of sexual desire and difficulty reaching orgasm. For many women, testosterone replacement restores sexual desire.
Cardiovascular protection. Hormone replacement therapy can significantly reduce cardiovascular disease where other therapies have failed to do so.
Improved Quality of Life. Hormone replacement improves sleep, relief from hot flashes and night sweats, and increases concentration and memory.
Our Expertise: Your Decision
Every healthcare decision you make has consequences. The public, in general, places a great deal of trust in healthcare providers, and those providers offer expertise and advice based on their experience and review of the most recent research on treating medical conditions.
Staying informed about medicine as a layperson can be challenging for the reasons we have stated, but raising questions about care is your right and our expectation. You can count on us to stay apprised of the most recent research in making recommendations about your health and well-being.