Backdrop: 1) The Pharmaceutical industry’s (pharma) prime goal is the maximization of profits;
public service is their hype. I call this tobacco ethics. 2) Know how broken the system is: thus read Marketing
Science, on the FDA , how doctors are their pawns, and watch Prof. Angell. The attack on HRT follows the pattern of eliminating
an off-patent drug that reduces profits, in this case prevents chronic conditions (above).
By convincing doctors and women that estrogen is dangerous, when they get breast or cervical cancer, they can put her
for life on a drug that blocks estrogen. Estrogen
Basics: “Estrogens [Wikipedia] are a group of related compounds named for their importance in the estrous cycle of humans and 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, and the suffix -gen, meaning "producer of". Estrogens are synthesized
in all vertebrates as well as some insects. 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. Additionally, estrogens have been shown to activate a G protein-coupled receptor, GPR30. 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 corporalutea. Some estrogens are also produced in smaller amounts
by the liver, [the brain & fat cells] adrenal glands, and the breasts. Androstenedione has weak androgenic activity [muscle
building] & 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. Inflammation and oxidative damage are causal factors
for cognitive decline, arthritis, Alzheimer’s disease and other conditions. Estrogens
circulate in the blood in association with proteins including sex hormone binding globulin and albumin (50-80%), & a significant
portion is in the form of a sulfate. It is distributed in most tissues, especially
the breast, uterine, vagina, 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) & androstenedione decline gradually with age. Progesterone (P4) is the most important of a class of hormones called progestogens. [Wiki lists 12 major effects of progesterone. They are structurally
similar to the estrogens.] 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 orally bioavailability, except in oil]. A progestin is a synthetic progestogen that has progestational effects similar to progesterone. The two most common uses of progestins are for hormonal contraception (either alone or with an estrogen), and to prevent endometrial hyperplasia [excess growth 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“ (Wiki 2009, more, journal articles).
^^^^^^ Setting the record straight Prempro
vs. natural HRT -- for more ^^^^^^^
Bad Press: Prempro, one of the first HRTs, 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) UK completed in 1998 which used Prempro; moreover, earlier studies singled out (medroxyprogesterone) MPA as the cause for the increased risk of breast cancer (Goodman & Gilman 2006, 1552).
Prempro consists of an estrogen cocktail derived from pregnant mare’s
urine to which is added the synthetic progestin MPA. (The cruel treatment of mares and subsequent slaughter 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.” 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%.” “MPA antagonizes this athero-protective effect [on coronary arteries]” at 1997. Though “all causes of mortality were not effected”, the press highlighted risks for HRT (undoubtedly
with a nod from their biggest advertiser), & HRT sales plummeted. 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 & pharma) and still first in sales. Based on the WHI, NIH issued this warning on all HRTs: “…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 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 Prempro 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, guidelines, and the NIH. This is another example of regulatory capture. Tobacco ethics
CONFIRMATION: Set Up to Fail
was published in the highly acclaimed science journal, Nature, 09/09/2010: “Is Nature ignorant of
the vital fact that Prempro contains no progesterone, but instead the artificial progestogen
Provera [MPA]. The other component is Premarin
(conjugated estrogen), which is a very uncertain, patent mixture of substances from the urine of pregnant mares…. [equine
estrogens] have crucially different effects. Prempro is totally unrepresentative of any other product used for HRT purposes…. . Much of it was known before the NIH chose to use Prempro
in its intended landmark study. Using a study of the effects of Prempro to attack the entire use
of HRT has, through needless fear, caused millions of women to forgo considerable
benefits of HRT using better products. This point has been repeatedly made
by endocrinologists. Why does Nature not know it?--END
that it borders on a tragedy that Premarin and Provera [the 2 compounds in Prempro] were chosen as the only HRT treatments
[for the WHI Study]”. Another researcher finds that Provera [MPA]--and
no other progestin--blocks the mechanisms that allow estrogen to fight the brain's immune response to Alzheimer's…. Bruce S. McEwen Neuroendocrinologist of the Rockefeller
University is unequivocally critical of the study: "I think that it borders on a tragedy that Premarin and Provera were
chosen as the only HRT treatments." “With Medroxyprogesterone [MPA] in Provera you are activating two receptors involved with cell division in the breast,"
she says, "and that's the culprit, not estrogen [for breast cancer].” Recent
research shows that Provera interferes with estrogen's ability to prevent memory loss
and dementia. “Estrogen is able to protect neurons against toxic assaults that are associated with Alzheimer's disease," notes
Roberta Diaz Brinton, a neuroscientist at the University of Southern California…. she found “that Provera--and no other progestin--blocks the mechanisms that allow
estrogen to fight the brain's immune response to Alzheimer's”. This immune response wears away at brain cells
and causes them to leak neurotransmitters such as glutamate, which overloads and kills neurons.” Hormone Hysteria, Scientific
---- BENEFITS OF HRT ---
Cardiovascular disease (CVD) & MI: “estrogen lowered
… 37% LDL …, extends life 2.1 years,” Braunwald, Heart Disease 5th
Ed, 97, p 1708. “HRT decreases CAD morbidity and CAD mortality …
was 0.56 compared to subjects not taking estrogen” Braunwald 1142; another 50%, 16 vs 33, 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 MI deaths for estradiol vs. 56 for placebo (115%). A
meta-study found and a 50% reduction of Coronary Heart Disease. Lowers hypertension risk. Two AHA studies explain mechanisms of cardio arteries protection and Wiki, also, Angina pain is associated with low estrogen, treated. Calcification of arteries is strongly associated with MI. HRT lower calcification of coronary arteries—at, using Prempro.
Cholesterol effects, percentage of reduction in LDL with
E 37%, with E +PA 46% (E is equine estrogen and PA is medroxyprogesterone Braunwald, Table 51-2). Estrogen is held to significantly protect LDL from oxidation at . “E2 at a concentration
of 1 μmol/L inhibited LDL oxidation by 37% to 62% at the various concentrations of copper” at. Oxidized LDL in the tunica media of the artery is held to by pharma to be the major cause for atherosclerosis and
Breast cancer risk decreased:
73% less for 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 (in Prempro) increases the risk of breast cancer” some 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. HRT also prevent skin 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.”
Breast cancer survival: “Cancers in women who use HRT are often less advanced, and lower mortality has been reported in
those who use HRT than in nonusers… The association of HRT with lower proliferation
rate and smaller tumor size was exclusively caused by ER-positive tumors” at. After diagnosis 72% higher survival: “The risk of death was lower among the HRT survivors; odds ratio 0.28…”
at, Also, breast cancer mortality rate of 5 per 1000 person years in HRT users
compared to 15 in nonusers, at. For negative results, pharma used the progestin MPA (WHI study); other
progestins could be similar; however, “progesterone combined with estradiol induces apoptosis [cancer cell death]”
Alzheimer’s disease with past long-term HRT, 7
vs 30 control. Estrogen is neuro-protective by inhibiting
oxidative damage. Progesterone is also neuro-protective: used in large doses
following trauma “to limit central nervous system damage.” Again MPA in WHI study increased risk of dementia, 40 cases of dementia versus 21 in the placebo group,
Parkinson’s disease,” loss of estrogen resulted in decrease
neuron density in the substantia nigra (structure of brain damaged by Parkinson’s disease), and restoration of estrogen
in increased density” at, and. Again MPA exacerbates condition & risk, at. Pharma of course does junk science to show that HRT does not affect the course
of the disease.
Cognitive Function: “There
are plausible biological mechanisms by which estrogen might lead to improved cognition.”
Longevity: Telomere numbers of units on the end of DNA are essential for cell longevity
and functionality—see Wiki.
It has been shown both in animal and human studies that treatment with estradiol lengthens through action on telomerase
the number of telomere units, see careful matched study of HT therapy, and, and, and, for animals. This action
on telomerase in part explains the many benefits from estradiol.
Programed death through menopause is to remove
elderly women from the community, thus the precipitous decline in health of women after menopause. To slow this process requires
the taking of natural HRT.
Macular degeneration, and hearing: HRT resulted in a 36% reduction and other eye pathologies.
“Non-alcoholic fatty liver disease is also more common among men than women in all age groups until
age 60, where the prevalence between sexes equalize. This is due to the protective nature of estrogen,” Wiki.— for diet's role.
Obesity & Diabetes:
the drop of estradiol increases LPL which regulates weight, distribution of fat, and activity. Gary Taubes, Good Calories, Bad Calories, 398, Taubes Why we Get Fat, 90-91, and Wade at, In Obese estrone +40% at. Weight related issues (metabolic syndrome, insulin resistance,
& diabetes) are associated with drop in estradiol, at.
Osteoporosis: “Bone loss increases after menopause due to lower levels of estrogen.,. [causes removal of ovaries” Wiki “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. Numerous journal articles hold that progesterone work with estradiol to increase remodeling of bone,
at, and, and.
Rheumatoid Arthritis (RA): “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” also, & lowers RA CVD deaths.
(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”. Progesterone most important.
Sarcopenia age related
loss of skeletal muscle mass with age is associated with low level of estrogen & testosterone in 22.6% in older postmenopausal women not receiving estrogen or TTT. TTT prevents and reverses sarcopenia, and.
Skin healthier 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”, slows skin aging, also, and less skin cancer, 2008.
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.
Thrombosis: an 8% reduction in risk of with esterfied
estrogen while those on Prempro had a 65% elevated risk JAMA 04, and; a 23% reduction exogenous estrogen (5.1% of cases versus 6.3% control cohort).
Sexual Satisfaction: prevents vaginal atrophy, “HRT improves sexual function” better, estradiol & testosterone, &.
Mood elevation and depression: “Numerous molecular and clinical studies have implicated estrogen in modulating brain
function including that related to mood,” treatment of mood disorders and depression no additional
10 Reasons for HRT: Menopause Int. & Oncology: Both
list the above benefits, and the latter advises HRT for survivors of breast cancer because of “a 70% reduction in the risk of death” during
the 15 years, also.
Breast density maintained for women on HRT. The
difference has been repeatedly noted on mammograms.
natural HRT (NHRT) at dose comparable to the Danish study (Trisekvens sequential 2 mg estradiol
with a progestin). NHRT is part of nature’s
clock. NHRT sets the body’s
clock to premenopausal and thereby reduces the rise for age-related chronic conditions.
Their lack causes the precipitous decline after menopause. Life extension with long-term NHRT is over 4 years. True to profits-first, corporate tobacco ethics,
pharma offers 1) HRT in too low a dose; 2) synthetic estrogens, horse estrogen, and synthetic progesterone (progestins) of
questionable value and safety; 3) human estrogens estrone (E1), Estriol (E3), estetrol (E4) which are less bioactive and they
block some of the action of estradiol, the best estrogen; 4) the other progestins could be like MPA and block some
of the benefits of estradiol. For hot flashes, NIH guidelines include a major tranquilizer (SSRI) or an estrogen blocker such as Tamoxifen. My wife takes 50 mg progesterone micronized in oil capsule with 2 mg estradiol prepared by a compounding pharmacy. Alternate, which she once took, is topical lotion of 8 mg of estradiol + 100 mg progesterone (absorption
is 10%). The use of sequential treatment with progesterone
used for the last 10 days is probably as good or better, but unfortunately the evidence is thin. Some doctors favor the sequential treatment because it duplicates the body’s natural cycle. If concerned about muscle strength, add 10 mg of testosterone in
lotion to reverse
sarcopenia, androgen deficiency, & to improve libido without reduction in estradiol. For lotion, moisten skin then apply as widely as possible over the torso and face and rub it in. Tell
your physician you are aware of risks and are convinced of benefits of NHRT outweigh
risk, then give him a copy 2010 journal article. Tell him you observed the benefits in a friend & a relative and
want the same. Most doctors will comply. Beware of hormone balancing; some
doctors are milking the insurance. The evidence for sequential HRT is weak and
it has a lower compliance because of vaginal bleeding—at 1997. For more on Why Natural HRT. Avoid
“bio-identical” plant estrogens and progesterones—they aren’t identical to human sex hormones. These hormones occupy receptors with uncertain action and possible block benefits
like MPA, and have low bio-availability. There is a lack of quality clinical
trials on them. The youthful free-serum estradiol level is > 300 pmol/L, or > 80 pg/mL. Estrogen is involved in both weight regulation and fat distribution. Low estrogen entails for most a gain in unhealthy visceral (adnominal) fat.
Reset you bio-clock with NHRT, fix your diet, learn about the corruption caused by pharma (on YouTube), and why doctors are their pharma’s pawns. For testimonials and more on osteoporosis, link.
^^^^^^^^^^^^^^^^^^ Non-technical summation ^^^^^^^^^^^^^^^
Natural Estrogen (Estradiol) with
progesterone NHRT: 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 (E2) has major health
benefits. Two--estriol (E3)
(E4)--are found in pregnant women and block estradiol. Big pharma being against hormone replacement
therapy (HRT) markets ineffective products including those containing estriol
and estetrol, and estradiol at too low a dose & with inferior progestins
such as in the best-selling Prempro.
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 most of the positive effects of
estrogen. Thus the results of
WHI study funded by the FDA apply only for Prempro. Nevertheless he FDA warns that HRT has only
one valid medical use, to manage hot flashes, and should be used at the lowest
dose for the shortest time. Thus
has used marketing science & guidelines to overturn 4 decades of positive results
for HRT: Alzheimer’s 83%, Heart
attacks 51%, Coronary Heart
Disease 50%, Colorectal Cancer 46%, Breast Cancer 73%, Thrombosis 8%, Macular
Degeneration 65%, osteoporosis fractures 90%, & 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. These
results occur because estrogen & progesterone receptors set the body to
“premenopausal” maintenance. Through
their many functions, these hormones are part of nature’s clock for death in
the 7th decade.
The lack of estradiol & progesterone is
the reason for the precipitous decline in health of women after menopause. Life extension with long-term NHRT is over 4 years, and twice that with a natural diet. Progesterone (P4),
the major natural
occurring progestogen, is similar to estrogen and works together. It has
numerous benefits, while some of the artificial progestins are clearly harmful
(such as stimulating the growth of breast cancer), and none have been
adequately researched as to side effects.
Like testosterone, a very similar hormone, at higher dose, more
benefits. A sufficient dose is available
only from a compounding pharmacy
mg of estradiol plus 100 mg of micronized progesterone) in a capsule; or you
can use a lotion obtained in a dose of 4 mgs estradiol plus 100 mg of
progesterone per application (there is a 15%
absorption rate with topical hormones). Apply widely as possible over the torso,
back, shoulders, underarms, and face using water and rubbing it in to promote
better absorption. Ideal free-serum estradiol
level is 200-500
sources for HRT are not natural and are metabolized by the liver on first pass
from the digestive system. These
mimics fail to perform well and have adverse consequences (see MPA above).
Mimic can occupy sites that estradiol would
go to and block their action, one of which is the control of appetite. 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 convincing scientific evidence. In Europe excellent results have
been obtained with sequential Trisekvens; Novo Nordisk, Denmark, though with greater side effects (nausea,
break-through bleed), thus low compliance. Since ovulation is not possible
sequential NHRT lacks benefits (see
Natural HRT, below). Keep it simple,
and send the message to your
cells that you are premenopausal.
Prempro has been the leading selling HRT since the mid 40s in the US,
and it still is. The issues with
mare’s urine estrogens has been known for decades by scientist including those
in the FDA as inferior of the other HRT & 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.
Unfortunately the FDA acts
promote products for pharma while minimally regulating in the public’s interest—see
Consumer Report’s article,
Why Natural HRT, which estrogens, higher dose, and non-sequential
There are 4 superior choices
for natural hormone replacement
therapy (NHRT). 1) that of
estradiol and progesterone; 2) a
sequential uses of those hormone to mimic the women’s premenopausal cycle; 3)
to take all 3 natural estrogens plus
progesterone, and 4)
to take them sequentially. What is the
evidence to support these choices?
Unfortunately, dispositive quality evidence is lacking: no long-term
clinical trials; nor are there
short-term clinical trials. The reason
is simple, the profit margin in insufficient on off patent drugs to justify
such trials. Products natural to the
body cannot be patented (with a few exceptions). Contributing factor: in the golden age of medicine, when there was
still significant amount of university ran and clinical trials with just mere
funding by pharma, progesterone was available only as a topical cream (not
orally active). Today that has changed,
and like CoQ10 it is available in an oil based capsule micronized. For these
reasons the evidence for NHRT is mainly anecdotal. The second source for evidence is population
studies (epidemiological), but nearly all of them have a major flaw, they
gather the evidence from all women on HRT, independent of formulation. A few
epidemiological studies separate women
according to type of products, & a few clinical trials are for one product. These provide evidence suggestive that 1 of
the 4 choices could be better.
So why do I favor # 1), non-sequential progesterone
First, estradiol has been used in a number of preparations with
excellent results. In the French
epidemiological study (EN3) estrogen showed no increase in breast cancer; &
Prempro the greatest increase (due to the progestin MPA). E3N
study supports the use with estrogen with progesterone and not a
progestin. Second progesterone and
estradiol work together in the body, thus to use a synthetic form, called a progestin,
has consistently resulted in lower benefits—see MPA example above. Third,
for those using a better progestins,
their results were superior to using only estradiol, ethinyl estradiol, and
this favors the combination NHRT. Fourth
those who used estradiol and testosterone (common in Europe in the 1980-90s)
instead of synthetic progestin had very good results; this also supports the
use of progesterone. Fifth, there is no
clinical evidence supporting comparable benefits from the other forms of
estrogen comparable to those from estradiol; this supports the use of estradiol. Sixth,
the laboratory work testing with
estradiol indicates that it is the most important of the 4 estrogens. Seventh
in the Danish study of the sequential
high-dose (tri-cyclic) Trisekvens
(a product only available in Europe), the results were excellent. Eight, compliance
issue because of mild side
effects of nausea and break-through bleeding like those of a menstrual
period. Ninth, the paucity of evidence
supporting for postmenopausal women a need for having cyclic hormones. Tenth, cyclic NHRT would
cost more and is less convenient to take. Eleventh, if I in recommended sequential,
some woman would find a doctor who charges many times more for monitoring blood
hormone levels and providing a custom balanced hormone cocktail based on her
blood work. This lacks sound
science. Conclusion: Thus recommend
#1, NHRT of estradiol with progesterone from a compounding pharmacy, 2
mg estradiol and 100 mg of micronized progesterone in oil as a capsule.
Dr. Jonathan V. Wright in Natural
Hormone Replacement (1997) recommends
all 3 hormones.
Note, the large
trials government funded trials (HERS
and WHI) are designed to show HRT as
dangerous, since pharma opposes for business reason HRT.
Esterified estrogen and ethinyl estradiol are commonly used instead of
estradiol because of longer half-life--still available. They are
derivatives of estradiol, of which for
esterified estrogen there are over 30--a way for pharma to obtain patents of
exclusivity. I consider these 2
equivalent to estradiol, though some of these forms must be inferior.
 The women in the treated group with
an intact uterus started treatment with 2 mg synthetic 17-β-estradiol for 12
days, 2 mg 17-β-estradiol plus 1 mg norethisterone acetate for 10 days, and 1
mg 17-β-estradiol for six days (Trisekvens;
Novo Nordisk, Denmark).
. “Because of break-through
with sequential Trisekvens, non-sequential
combined HRT form of Trisekvens was better received.” At.
Over 95% of HRT products are not sequential and the literature does not indicate
an associated problems. Nor are
benefits exceptional favorable from sequential Nordisc compared to the best of
Why the higher
dose of estradiol? This is comparable to that used in Trisekvens
which had excellent results. In the
1960s through the 1980s the higher dose of estradiol was the norm, and during
that period the numerous benefits were uncovered in epidemiological studies;
thus higher dose is better. Second, in
men higher dose testosterone
has significantly greater health benefits, more evidence for a higher dose of
estradiol. Third, pharma in their
opposition to these healthful hormones recommends the lowest dose, still more
evidence that the higher is better.
The goals is to restore youthful benefits and avoid age related
conditions, thus to restore hormones to youthful levels. Natural products have
evolved to work in the
body through receptors and complex feedback systems; thus synthetic chemicals don’t
function as well. Natural hormones have
lower risk of side effect (for which the reporting system is broken). Of the over 100 synthetic hormones, there is
no evidence that they work better, and only one has very good results in a
clinical trial—unfortunately the Danish product is not licensed in the US.
Why not branded drugs
for HRT? With the support of the NIH, pharma
opposes HRT since 1990s, thus current products have various issues: 1) dose
is too low for most of the healthful
benefits; viz. not equivalent to 2 mg of estradiol. Fernhrt has only .25 mcg
of ethinyl estradiol
(1/8th the recommended 2 mg).
Estragyn (estrone) is a 0.1 gm vaginal cream; but estrone is far less
bioactive than estradiol, and the absorption rate is under 25%. 2) A
number of products are not estrogen, but estrogen antagonists (they occupy
estrogen receptors on the cells and thus block estradiol’s action). Tamoxifen
is one of several estrogen
antagonists marketed as HRT. 3) Estrogens
with harmful progestins: Femhrt has the progestin norethindrone acetate, and
Prempro has the progestin MPA. 4) Use
less bioactive estrogens such as estrone, estriol, derivatives of the
estrogens, and mare’s estrogen in Premarin.
5) For hot flashes several tranquilizers of the SSRI and dopamine
agonist types have been approved, and many more are used off-label.
finding a doctor who will prescribe HRT as recommended. Be prepared with
an answer when
your doctor suggests that you try something else first. You can refer to books, such as Natural
Hormone Replacement (the Amazon reviews has good material). Ask him to
read an article in Menopause Internal Journal which I have pasted with link. Refer to the experience of friends, or other
articles you have read. And you
simply tell him that the 40 years of positive journal literature was not
overturned by the flaw Women’s Health Initiative Study (WHI) which used
estrogen from mare’s urine along with MPA as a progestin, which has been known
to block some of the benefits of estrogen and increase risk for breast cancer.
doctors have fallen for the anti-HRT myths:
promotes breast cancer, and benefits aren’t worth the risks. As argued at HRT, this is false for NHRT
and most formulations of HRT. Thus
get HRT or NHRT long-term (not just
for hot flashes) requires a physician who is willing to do what once was the
norm before 2002. The earlier studies
HRT were not wrong. I about 3/4th
of doctors will write a prescription for NHRT
for their regular patient after lecturing on the risks and a referral for a
He is protecting himself from possible
litigation. Copy this 2010 journal article Ten
Reasons to be Happy About Hormone Replacement Therapy: A Guide for Patients to
MS word and print it. Read it before
seeing him, and give him a copy. These hormones
are part of nature’s clock for us to die in the 7th decade. The
estradiol & progesterone is the reason for the precipitous decline in
health of women after menopause. Sending
a message to your body that you are premenstrual; it is worth the effort to jump through a
few of pharma’s hoops.
of uncertain effects: The use of progestins, in particular medroxyprogesterone
post-menopausal symptoms have been associated with increased risk of blood
clots and breast
cancer in a study carried out by the Women's
study did not involve dydrogesterone, it is possible, but not certain, that it
too increases these risks. [The blood clots a key risk factor for MI,
explains why with Prempro used in the WHI) there was no reduction in MI—while
with other formulas of HRT the reduction is 35% or greater. The WHI has a second
flaw in that of 55%
equine estrogen, which is of uncertain consequences, thus the estrogen alone
arm of the study is applies only to Premarin —jk.] https://en.wikipedia.org/wiki/Dydrogesterone
Our in vitro results indicate that not all progestogens act
equally on breast cancer cells. Some progestogens (medroxyprogesterone acetate
norethisterone acetate (NETA) and dienogest) alone or
combined with estradiol (E2) stimulate proliferation of breast cancer cells,
while others (dihydrodydrogesterone (DHD), the active metabolite of
dydrogesterone, tibolone and progesterone (Prog)) alone or combined with
estradiol induce apoptosis [prevents cancer]. Further pharmacological and clinical
should be initiated to evaluate these findings in vivo.
women in the treated group with an intact uterus started treatment with 2 mg
synthetic 17-β-estradiol for 12 days, 2 mg 17-β-estradiol plus 1 mg
norethisterone acetate for 10 days, and 1 mg 17-β-estradiol for six days (Trisekvens;
Novo Nordisk, Denmark). http://www.bmj.com/content/345/bmj.e6409?etoc=
. “Because of break-through bleeding
with sequential Trisekvens, non-sequential
combined HRT form of Trisekvens was better received.” At.
 Testosterone is structurally
the same as
estradiol but for one group on the molecule.
In the body women convert some of their estradiol to testosterone so
that there level is about 1/10 that of a man’s.
Men convert some of their testosterone to estradiol.
 Progestins are of uncertain effects:
The use of progestins, in particular medroxyprogesterone
acetate, in treating post-menopausal
symptoms have been associated with increased risk of blood clots and breast cancer in a study
carried out by the Women's
Health Initiative. While the study
did not involve dydrogesterone, it is possible, but not certain, that it too
increases these risks. [The blood clots a key risk
factor for MI,
explains why with Prempro used in the WHI) there was no reduction in MI—while
with other formulas of HRT the reduction is 35% or greater. The WHI has a second flaw in that of 55% equine
estrogen, which is of uncertain value, thus the estrogen alone arm of the study
is applies only to Premarin —jk.] https://en.wikipedia.org/wiki/Dydrogesterone
 Men have a similar
problem in obtaining a
testosterone of sufficient dose, which entails using a compounding