Neal Rouzier, M.D. analyzes the history and implications of hormone replacement therapy and menopause.

Neal Rouzier, MD

For many years the medical establishment has recommended hormone replacement therapy as a necessary component of health and wellbeing for all menopausal women.  After the Women’s Health Initiative (WHI) trial was published in 2003, the medical establishment suddenly repealed (or reversed) their recommendations, as the WHI discovered hormone therapy was related to an increased risk of breast cancer, heart disease, and stroke. Based on this statistical analysis, some medical experts declare that the risks associated with taking hormone replacement therapy (HRT) outweigh any benefits. Yet, other experts claim that these statistical results should be discredited, as the benefits outweigh the risks. 

What is the correct (or accurate) observation? We know the WHI trial reviewed the effects of synthetic hormones that were predicted and demonstrated to have detrimental consequences. A closer examination of the trial indicates subjects participating in the WHI were older women with pre-established vascular disease. This put them at greater risk for the negative outcomes they experienced. Re-analysis of the WHI data, as well as data from other studies, demonstrates that the results do not apply to younger women (under 60 years of age). In contrast to older women, women under 60 years old benefited from hormone therapy, as the study found younger subjects experienced a decreased risk of heart attacks and strokes. Furthermore, women under 60 years old taking HRT had greater protection against the development of Cardiovascular Disease (CVD).

The WHI trial demonstrated a significant increase in breast cancer occurred among subjects taking an estrogen and progestin combination (Premarin and Provera). However when the estrogen-only arm of the study was analyzed, researchers discovered breast cancer risks did not increase, but actually decreased among subjects. These findings imply that different types of hormone therapies can result in different effects, depending on whether the hormone therapy is a synthetic, chemically-altered hormone or biologically identical hormone.

As evidenced by the recent proliferation of articles and talk shows discussing bio identical hormone therapy, there is an increasing movement to understand how biologically identical hormones differ from synthetic hormones. Many studies have been conducted in the United States demonstrating bio identical hormone therapy is a superior, safe, and effective hormone treatment. Literally hundreds of medical articles document and demonstrate bio identical hormones have positive health benefits, with fewer side effects that have been exhibited in the use of synthetic hormone therapies.

Over 50 years of studies have demonstrated that women can suffer a significant deterioration in their health, when their hormone levels decline upon reaching menopause. These studies have found that restoring hormone levels to pre-menopausal levels can protect women from detrimental health ailments. The decline in estrogen that occurs during menopause predisposes women to a sudden increase in heart disease, strokes, Alzheimer’s disease, osteoporosis, urogenital, and vaginal atrophy. Additionally, women can encounter tooth decay, vision impairments, skin atrophy, depression, early morbidity, and mortality. In contrast to synthetic medroxyprogesterone (Provera), studies have demonstrated a decreased incidence of breast cancer exists with the use of natural progesterone. Furthermore, natural progesterone can protect against heart disease, breast cancer, bone loss, vaginal atrophy, dementia, and depression.

I would encourage all practitioners who treat (or care for) patients with peri-menopause, menopause, and andropause to become familiar with the medical literature on hormone replacement therapy. A research review will provide compelling insights that can help you recognize the health benefits associated with hormone replacement therapy. 

Neal Rouzier, MD
Director, Preventive Medicine Clinics of the Desert

Author: “How To Achieve Healthy Aging” Why Everyone Should Replace Hormones, A Review of the Medical Literature

Lecturer: “Mastering the Protocols for Hormone Replacement Therapy” The Most Scientific, Evidence-Based Seminars Series Available Today