GET TO KNOW YOUR HEALTH:  HRT

THE COLD HARD FACTS OF HRT

*Disclaimer – Cold facts are most likely if HRT is used, otherwise I make no promises to the likelihood of the facts actually being hot and flushy…

 Firstly, this isn’t an article about menopause.

If you want more info about that, head to www.primecompounding.com.au or look on the Grapevine website as it was covered a few years ago.  Hormone replacement therapy (HRT) is given to correct symptoms caused by many conditions that result in abnormal hormone levels, such as menopause; and for ease of writing, menopause will be used as a proxy name and example for these many conditions related.  For those of you thinking, “HA!   What would a 30 year old guy know? Who does he think he is?  Thinking he can tell me anythin….” *voice trails off angrily.  Well, while I’d like to think the pharmacy thing helps a little, any claim mostly comes from the fact that I went through puberty as my mum went through menopause and we came out without losing any fingers, toes or family members along the way.   But that’s enough about me, let talk about you…

As discussed over the last few months, hormone replacement therapy aims to replicate the actions of normal hormone levels in the body and more recently, to ideally replace the hormones in the body exactly.  A quick history:

1943 – first synthetic HRT medication (made from pregnant mares urine = estrogen only);

1975 – Research found estrogen only therapy increased the risk of endometrial cancer in women with an intact uterus which lead to progestin being combined with most therapies;

2002 – The results of the huge clinical trial called the Women’s Health Initiative (WHI), were published raising concerns about HRT increasing breast cancer rates (up 33%) and risk of heart disease;

2004 – Further analysis of the WHI indicates conclusions were drawn impulsively and most didn’t stand up to scrutiny (eg. the 33% increase = an extra 8/10,000 cases p.a. which balanced the 8/10,000 cases p.a. decrease in all other cancers).

2007 – Current WHI outcomes – HRT reduces risk of death from any cause (overall mortality) slightly, moderately reduces risk of heart disease; and that no clear increase in risk from stroke exists when HRT is initiated during pre or perimenopauseal.  The risk trend leads back to overall neutrality by 10yrs postmenopausal;

2012 – Danish study confirmed reduced risk of heart disease/mortality in women if started shortly after menopause.

 

*Intermission – 30 seconds* (to avoid eye strain after all the dates and acronyms)

 

What does all this mean?  The mass panic that followed the 2002 trial lead to an overall reduction in the use of HRT by between 65 and 80% worldwide.  Even in light of the overwhelming new evidence, these numbers haven’t gone back up significantly since.  Primarily due to popularist media and reporting, the majority of an entire generation of women who would have otherwise safely improved their quality of life, and even slightly decreased their overall risk of death have gone wanting;  But don’t get me wrong, HRT is not for everyone.  Certain women will have an unfavourable risk profile due to things like age or previous history of breast cancer, so a detailed HRT risk and treatment option discussion with your GP is imperative.

Rather than split this topic into multiple parts, the first two categories will be skipped . . . However I will cover them fully on the Prime website so feel free to head over if you want to know more.

While pharmaceutical HRT treatments are moderately new in the grand scheme of things, they have been put through the wringer a few times already and are still standing.  The latest round has seen novel treatment options decreasing in Australia since 2002, due in part from the decrease in HRT use rates following the WHI.  Over time however, as more studies are published, the evidence has started to indicated a slight preference towards hormones that are emerging as possibly safer.  Bioidentical hormones are building a case to prove their better safety profile (even if only due to their route of administration being “not the stomach”).  The Bioidentical hormone topic is huge and I’ll only go briefly over it so to begin, they are hormone molecules (isolated mainly from yams) that are chemically identical to the ones we make inside us.  Recently, drug companies have started researching the differences between bioidentical and synthetics, and while very few differences were found, they were all beneficial.  Very few bioidentical hormones are commercially available in Australia, which has allowed compounding pharmacies to fill that gap.  I preface the next line with, I said this before I had a compounding lab (and sent people to other pharmacies to get it):  if HRT is to be used, I think the tailored, bioidentical compounded option is honestly, the best option currently in the market.  And after the 15+ hours of reading/research I do for these articles, my belief has only been strengthened in this therapy.  Primarily as every prescription written is unique and tailored to each individual patient, which allows the medication to be made from a formula specific to the individual.  Combine that with identical nature of our own hormones molecules to the molecules used in bioidentical compounds and you can start to see why 40% of the HRT medications used in the US are compounded bioidentical hormones.  Big pharma just love us….

 

Well that brings us to the end of another  months article, and to the end of the much greater topic of  sex hormones.  My usual finale applies even more than usual this time, I have heaps more information that simply won’t fit onto one page.  So if you are interested in any aspect of the hormone topic, I probably know a fair amount about it right now, so get in while the irons hot, drop into the pharmacy and I should be able to answer (hopefully) any questions you have about the topic.  Otherwise all the articles are up on the Prime Compounding website, or you can always drop in and see another local healthcare professional.

Written by Andrew Harvey

www.primecompounding.com.au

Dayboro Pharmacy,

Phone 3425 1435,

Mon – Fri 8.30am – 5.30pm

Sat 8.30am – 12.30pm *

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