Good article on hormones, types and pros and cons

You'll have to sign in to read this. Maybe someone can cut and paste the whole thing on the board, me I'm not good at that kind of thing.

http://www.nytimes.com/2002/06/23/he...th/23GRAD.html


-- Marian

[edited below to avoid copyright violation--thank you for posting it AmazDing]

Thanks for the article. It was easy to understand and had some helpful information, especially just starting Premarin and looking for all the info I can get on it.

Thanks again for helping to sort some of the confusion.


Brenda

Thanks so much for pointing it out. Dorrie pointed it out to me also. I think it's best at showing what doctors are thinking.

However, I'm afraid that we can't reproduce copyrighted material here verbatim. We hostesses don't always catch it (and in the early days I was guilty of it, until I realized that this wasn't private but public communication and subject to copyright and "fair use" rules).

I think it's a great article, and available with a free registration, so I'm going to edit it down. Sorry about all this

So here it is rephrased (luckily most of this isn't news, so it's generally available information):

summary of The New York Times, June 23, 2002, "A User's Guide for Those Who Choose Hormone Replacements"
By DENISE GRADY

She first talks about the confusion of information and the debate about "medicalizing" a normal part of aging. She also mentions the contradictory studies that are coming out, which may [or may not] be resolved when the results from the Women's Health Initiative are published in 2006. [she doesn't mention that this is a study using only Premarin and Provera, so a lot of questions are still going to be hanging in the air.]

The picture has gotten much more cloudy now that "the American Heart Association has warned that women should not expect hormones to treat or prevent heart disease. And some doctors who were enthusiastic about hormone replacement are now less so, given its uncertain benefits and known risks, including higher odds of blood clots, gall bladder disease and, with prolonged use, breast cancer."

Everyone agrees that HRT is the best way to deal with hot flashes and other direct symptoms of menopause, such as vaginal atrophy, and that HRT helps prevent bone loss. Even doctors with serious doubts think it has some value at a low dose for a limited time when the symptoms are bad.

So then the article goes into the variety of choices and makes the following points:

1) If you have a uterus, you need progesterone, though progestins are the most commonly used form. They are used continuously or cycled and the side effects are bloating, depression and changes in vaginal bleeding.

2) The word "estrogen" actually refers to a group of different hormones.

3) Estrogens are made by the ovaries, adrenal glands, and in the placenta during pregnancy.

4) Estradiol is the main form before menopause and the most potent.

5) Estrone is the main form after menopause and weaker. Estrone can be converted to estradiol and vice versa.

6) Estriol is the main form made by the placenta.

7) Premarin is the most prescribed and converts to estrone and estradiol.

8) For vaginal problems, there are local creams.

9) And then she mentions the reasons why doctors are so stuck on it. "Premarin in pill form is one of the oldest estrogen products and most of the data on hormone replacement is based on it. Many doctors say they would rather prescribe it than other, less studied products."

10) Some doctors and patients favor "bio-identical" estradiol, estrone and estriol and progesterone.

11) Some doctors favor "micronized" estradiol and progesterone — suspensions of fine particles said to be easily absorbed in the digestive tract.

12) There are no large studies that compare the other choices with Premarin.

13) The support for the alternative forms of estrogen and progesterone come from small studies, the experience of doctors and patients, and the idea that imitating the body's own hormones makes sense.

It was nice to read that the doctors interviewed were willing to experiment if their patients insisted on experimenting. But the doctors were worried that the dose was uncontrolled and felt that bone density tests were needed as a follow up.

On of the doctors interviewed, "Dr. Michelle P. Warren, a professor of medicine and obstetrics and gynecology at Columbia University and the medical director of the university's Center for Menopause, Hormonal Disorders and Women's Health, said that theories about the relative merits of the different forms of estrogen were `a quagmire of nonscientific data'."

So, they aren't all open minded, but even she said she'd work with patients if they insisted. She was very uncomfortable about the lack of quality control from compounding pharmacies.

14) The last big choice is whether to have oral or a patch. Oral estrogen "hits the liver in a high dose" and that can increase blood clotting and raise triglycerides.

15) Patches, which are all estradiol, act more like the body's own estrogen and absorb into the blood directly. The patch might decrease the risk of clotting but that's not proved.

16) "Estrogen skin creams and gels, used in Europe, are not available in the United States, except in preparations meant only for vaginal use." [which actually isn't true since compounders can produce them]

Thank you, Trish. You are so good at making it easier to understand.

I would just like to add that I heard at some point that there was a study being done on bio-identical hormones, and that the results would come out in 2008. Hope this is true!