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Problems with HRT

The problems with conventional hormone replacement therapy (HRT)

Women are rarely informed of all the possible problems with HRT.

To start with...No one in their right mind would think of taking a sophisticated jet aircraft in flight and entering alien commands into its computer control system. Yet it seems that conventional HRT does the equivalent of this process when given to a number of women. Alien (and therefore unpredictable and unknown) commands are entered into the endocrine or main "computer control system" of her body through the drugs inaccurately called "hormones" used in HRT.

Description of Conventional "Hormone" Replacement

Premarin (also called conjugated estrogens) is a word composed from Pregnant Mare's Urine. This horse estrogen is the most commonly prescribed estrogen in the world. It is also the form of estrogen most commonly used in research, including taxpayer funded research.

This means that most of what we think we know about "estrogen replacement" in women is actually about horse estrogen "replacement" in humans. It is as yet unclear why studies aren't being done on the inexpensive and easily available bio-indentical human estrogen.

    The Problems with Premarin
    • heavy menstrual bleeding, cramping

    • breast tenderness

    • fluid retention, edema, weight gain, increased fat

    • headache, migraine

    • depression, anxiety

    • glucose intolerance, insulin resistance

    • estrogen dominance

    • stimulates growth of fibroids

    • worsens endometriosis

    • nausea, vomiting, cramping, bloating

    • leg cramps

    • eye problems

    • high blood pressure

    • increased blood clotting

    • venous thromboembolism

    • increased risk of endometrial and breast cancer

    • loss of scalp hair, growth of facial and body hair

    • gall bladder disease

    • pancreatitis
    The composition of horse estrogen is vastly different from human estrogen.

    The metabolic breakdown products of Premarin are biologically stronger and more active than the original equine estrogens. Various studies have shown that these breakdown products can produce DNA damage that is cancer-causing. So, for example, the incidence of breast cancer increases when women take Premarin.

    Premarin, like all conventional HRT, is prescribed in standard dosages and not tailored to individual requirements. This usually means women are often taking more "estrogen" that they need.

    It takes about eight weeks to clear Premarin out of the body. In contrast, natural hormones are completely metabolized and cleared in 6-12 hours.

    Premarin can easily, and usually does, throw a woman into Estrogen Dominance.

    It causes an excessive increase in Sex Hormone Binding Globulin(SHBG), which in turn blocks thyroid hormone function.

    Other forms of estrogen used in conventional HRT

    Note: The list of side effects of synthetic estrogens are similar to those of Premarin.

    The following lists some of the most commonly prescribed estrogens in HRT:

    • Estraderm, Climara, FemPatch, Menorest, Alora, Esclim, Vivelle-Dot/Vivelle: Patches applied 1-2 times a week. Contain 17 beta-estradiol, a natural(bioidentical)part of estrogen(without its natural partners, estrone and estriol>

    • Estrace: Natural(bio-identical) micronized estradiol in oral form.

    • Tri-Estrogen: 10% estrone, 10% estradiol, 80% estriol, in all natural (bioidentical)oral form.

    • Bi-Estrogen: 20% estradiol, 80% estriol, in natural(bioidentical)oral form.

    • Estinyl, Ogen, Ortho-Est, Estratab, Menest, Cenestin: Various versions of synthetic estrogens and synthetic horse estrogens.(Can you believe it?)

    • Premphase, Prempro, Ortho-Prefest, FemRt, CombiPatch: Various forms of synthetic partial or horse estrogens, plus progestins(synthetic).

    • Tri-Est plus OMP(oral micronized progesterone): 10% estrone, 10% estradiol, 80% estriol, plus 100 mg OMP.

    • Estratest: Synthetic estrogen plus synthetic testosterone.
    Progestins are chemical or drug imitations of progesterone, with disturbing side effects.

    Provera(medroxyprogesterone acetate)is the most common progestin. It is also used in PremPro, which is Premarin and Provera in combination.

    Most progestins are made by taking natural progesterone and altering the chemical structure so it can be patented. Another type of progestin is made by altering a synthetic form of testosterone.

    Problems with progestins
    • They suppress production of natural progesterone in the body.

    • They disrupt the steroid hormone pathways, which can cause both immediate and/or insidious undermining of both adrenal and gonadal function.

    • Since a steroid hormone pathway is fundamental to energy and vitality, these drugs are usually a prescription for chronic fatigue(and probably fibromyalgia). This is not conventionally recognized.

    • The myriad of side effects.
    Side Effects of Progestins
    • depression

    • anxiety, nervousness

    • fatigue, leading to chronic fatigue over time

    • fluid retention and breast tenderness, weight gain

    • migraine

    • coronary artery spasm

    • angina, palpitations

    • menstrual irregularities, spotting

    • glucose intolerance; promotes insulin resistance

    • general edema

    • nausea

    • insomnia, sleepiness

    • skin rashes, acne

    • hair loss on scalp, facial hair growth
    Possible life-threatening adverse effects of progestins
    • Coronary spasm-This is most significant: 90% of men who have heart attacks have atherosclerosis or obstruction of coronary arteries, but only 30% of women do. The majority of women who have heart attacks do so because of coronary artery spasm.

    • Stroke

    • Pulmonary embolism

    • Implicated in causing breast cancer.
    Other disturbing potential problems with progestins
The PDR(Physician's Desk Reference) advises patients to discontinue this drug if there is a sudden or partial loss of vision.
  • Liver disease

  • Increases the risk of birth defects(remember, progestins are in all oral contraceptives).

  • Gall bladder disease

  • The 2001 PDR states this about progestins: "The effect of prolonged use of this drug on pituitary, ovarian, adrenal, hepatic or uterine functions is unknown".
It needs to be emphasized that natural progesterone has NONE of these side effects. In fact, natural progesterone protects against many of the problems progestins cause.

Consider, for example, that one of progesterone's important functions is to protect and maintain pregnancy, while progestins are contraindicated in pregnancy because of potentially disastrous consequences to the fetus.

And finally, it is common for health professionals not to know that progestins and progesterone are not the same thing.

The following lists the most commonly prescribed progestins, and two prescription natural progesterones:

  • Provera, Amen, Cycrin: Various brands of oral medroxyprogesterone(MPA), a progestin(synthetic).

  • Aygestin, Micronor, Norlutin, Norlutate: Various brands of oral norethindrone acetate, a progestin(synthetic).

  • Prometrium, OMP(Oral Micronized Progesterone): Two brands of oral natural progesterone
Recent discoveries about conventional HRT

Cardiovascular protection

Cardiovascular disease is the number one cause of death in postmenopausal women. For decades it has been assumed that estrogen conferred cardiovascular protection that is lost at menopause. Premarin (and other drug forms of estrogen) has been routinely prescribed for postmenopausal heart protection, based on this assumption. In the last few years many studies have challenged this assumption. Here are a few examples:
  • HERS-Heart and Estrogen/Progesterone Replacement Study-This large study of women with existing heart disease found that "hormone replacement" in the form of Premarin and Provera did not decrease their risk of subsequent heart attack, but actually increased it significantly during the first year of use.

  • Women's Health Initiative is a taxpayer-funded study of thousands of women on Premarin (and sometimes Provera), which found that these "hormones" did not demonstrate protection against heart attack or other cardiovascular problems.

  • The 1997 Postmenopausal Estrogen/Progestin Intervention(PEPI) trial, a long term prospective study conducted by the National Institute of Health(NIH), assessed the effects of "hormone replacement therapy" for Premarin, Provera, and natural progesterone on bone and cardiovascular health. Reported in the Journal of the American Medical Association, this study showed that Premarin raised HDL levels, a possible cardiovascular protective effect, but when Provera was added, the effect was totally nullified. Natural progesterone did not nullify the possible protective effect.
Note: An interesting observation about this study: Although both estrogen and either progestin or progesterone was given to all participants, the significant gain in bone density was attributed entirely to estrogen by the AMA press-release.

    An excerpt from "The Greatest Experiment Ever Performed To Women Exploding the Estrogen Myth"
    "In June 2002, a large, randomized study of synthetic estrogen was stopped early because the risks to the postmenopausal women involved were outweighing the benefits, and many women who had been taking estrogen for years were left confused and angry. Seaman, a veteran women's health journalist (The Doctor's Case Against the Pill; Women and the Crisis in Sex Hormones), reminds readers that these findings are just the latest twist in the long and fascinating history of estrogen therapy. Seaman offers an explanation of how the estrogen drug Premarin was developed in the 1930s and then broadly marketed and prescribed to treat menopausal symptoms for the next five decades, despite the known increased risk of endometrial and breast cancer. She describes the historical roles played by different researchers, government officials. Seaman concludes with a chapter on environmental estrogens and an appendix on practical information on menopausal women's treatment options, including supplements. Seaman passionately and convincingly argues that women have been unnecessarily put at risk by doctors treating menopause as a disease."

This sort of arbitrary and questionable interpretation is often found in research studies.

  • The Nurse's Questionnaire Study-reported in The New England Journal of Medicine in 1991 documented a nearly 50% increase in strokes among HRT users. (It is fascinating to note that while their data recorded that fact, the authors stated that current estrogen use " not associated with any change in risk of stroke.")

  • Hormone Therapy Linked to Dementia

  • The Problems With Oral And Injected Contraceptives

    General considerations:

    • AKA The Pill, oral contraceptives come in a variety of mixtures of low-dose estrogen and progestin, or sometimes just progestin. Considered a "safe" form of contraception, the risks involved are often ignored or minimized.

    • Oral contraceptives are also given routinely by conventional medical practitioners for PMS and many other female hormonal problems, supposedly to "regulate" the female cycle.

    • Oral contraceptives work by "fooling" the endocrine system and preventing the normal female cycle and ovulation from occurring. This, of course, is not the same as regulation.

    • In fact, the concept that you can "regulate" the enormously complex and delicately balanced Hormonal Control System of the body by "fooling" and disrupting it with "drug hormones" whose consequences, especially long term, are only vaguely understood, is a peculiar form of insanity.

    • After stopping the pill, it takes varying lengths of time, from one month to many months, to reestablish a normal cycle.

    • Another version of synthetic hormone contraception is the time-released shot, which lasts for three months. Examples are Norplant and Depo-Provera. This form usually has much more severe side-effects.

      Some of the known risks from oral contraceptives

      • For many women it will participate in precipitating chronic fatigue/fibromyalgia over time.

      • Increased risk of blood clots.

      • Increased risk of stroke

      • Increased risk of high blood pressure

      • Increased risk of heart attack.

      • Increased risk of cervical dysplasia, ovarian cysts and infertility.

      • Increased risk of ovarian, breast and uterine cancer.

      • Increased risk of headaches and migraines.

      • Increased risk of immune dysfunction and autoimmune diseases.

      • Increased risk of thyroid and liver problems and cancers.

      • Reduced antioxidant levels, especially in the liver.

      • Nutritional deficiences, especially Folic Acid, B12, B6 and other B complex vitamins, Magnesium, Manganese, Zinc and Vitamin A.

      • Increased risk of gall bladder problems

      • Increases risk of other endocrine disorders.

      • Increased risk of loss of libido.

      • Increased risk of mental and emotional side effects.

      • Increased anti-anxiety, anti-depressant, or sleeping pill usage.

      • Higher rate of birth defects and birth marks in offspring.

      • Interferes with copper in the body, eventualy causing copper toxicity.

      • Contributes to Estrogen Dominance.

      • Interferes with steroid hormone balance.
      Natural Alternatives to HRT

      Many women choose not to use HRT. If you don’t want to take or cannot take HRT, there are other options available. For example, if osteoporosis is a concern, there are other drugs that are used to prevent and treat it. If vaginal dryness is a problem, there are many types of lubricants that can be helpful.

      A healthy lifestyle is important whether you use HRT or not. Here are some ways to stay healthy and feel well through menopause and beyond.

      Eat healthy foods. Your diet should be low in fat, rich in fruits and vegetables, and provide adequate calcium and vitamin D. A multivitamin and calcium supplement may be helpful.

      Get regular exercise. Try to get at least 30 minutes of exercise most days of the week.

      Don’t smoke.

      Use alcohol in moderation, if at all.

      What about herbal remedies and other alternatives? Some women turn to herbal remedies or to certain estrogen-like chemicals in plants (called phytoestrogens) for help. These products are not regulated through the same government system as drugs are. There is limited and conflicting research on their safety and effectiveness. Some of the herbal products can have harmful side effects or can interact with other drugs. Discover the function and the name of herbs commonly used for female health issues in our Herbal Allies: Introduction to Herbs. Discuss herbal remedies with a qualified healthcare provider before taking them, but do not summarily dismiss them because a medical practitioner has limited knowledge.

      There are some products that seem to help some women. Soy and soy products are high in phytoestrogens and may help with menopausal symptoms. The evidence regarding soy is conflicting, however. Clinical studies have shown that soy has little estrogenic activity in the brain and, therefore, doesn't help greatly with hot flashes and night sweats. In breast tissue, soy may stimulate the growth of breast cells and thus large amounts of soy may not be advised for breast cancer patients.

      Although phytoestrogens have some estrogenic activity and may have some of the same effects as HRT, their long-term safety is not clear and has not been adequately studied. Studies of black cohosh have found that it may reduce hot flashes and night sweats for some women. St. John’s Wort and chasteberry may help some women with depressed mood. Some recent studies comparing specific herbal products to placebo in controlled clinical trials have shown little or no effect for ginseng, dong quai, evening primrose oil, and red clover products on menopausal symptoms. However, there is a long tradition of the use of these and other herbal remedies in menopause.

      Learn more about natural approaches which can be used instead of, or in conjunction with, conventional hormone therapy in our Remedies for Menopausal Symptoms.

      Natural Alternatives for Menopause

      Bioidentical Progesterone Cream with Phytoestrogens

      Contains both progesterone and phytoestrogens which work together to provide women more effective control of their menopausal symptoms.

      Menopause Formula (PhytoBalance)

      PhytoBalance contains eight of the most tested and proven herbs that reduces hot flashes, night sweats, mood swings, irritability, and depression associated with perimenopause and menopause.

      Recommended Herbs

      Menopause-Condition Treatments


      Double Menopause Website
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