HRT - Hormone Replacement Therapy - Hormone Treatment

Joe Bella asked:


The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial not only validated the beneficial effects of hormone-replacement therapy (HRT) on serum cholesterol, it also turned the spotlight on natural progesterone. That hormone appeared to be more effective than the synthetic progesterone medroxyprogesterone acetate, or MPA, (Provera) in preserving estrogen’s beneficial effects on the heart and was just as effective in preventing estrogen -induced overgrowth of the uterine lining.

Moreover, earlier studies had indicated that natural progesterone’s side effects are minor. Some women taking it experience some drowsiness, but they are spared many of the symptoms associated with MPA - fluid retention, breast tenderness, and depression.

Many people have asked why doctors aren’t suggesting natural progesterone as an option for HRT. The answer is that in the United States natural progesterone isn’t available through conventional channels, and it is a relatively untested entity. However, it has a long and intriguing history.

Scientists first purified progesterone in 1934, but they soon found that the hormone was broken down to an inactive form in the intestine before it could be absorbed. In the 1950s chemists bonded progesterone to other compounds, which provided safe passage through the digestive system. These new synthetic compounds came to be known as “progestins.”

Progestins such as MPA and norgestrel were patented by pharmaceutical companies, studied extensively in clinical trials, and approved by the Food and Drug Administration for use in treating secondary amenorrhea, a condition in which premenopausal women who have had normal periods stop menstruating.

However, lower doses of progestins than those necessary to treat amenorrhea were found to eliminate endometrial overgrowth - a problem associated with postmenopausal estrogen use - and so progestins were added to HRT regimens. Yet the FDA hasn’t approved progestins specifically for HRT because there is little information on their long-term effects.

Researchers who continued to experiment with natural progesterone found that by pulverizing it into minute particles-a process called micronizationthey could make it absorbable in oral form. However, in early tests the oral preparation could not produce the sustained levels of progesterone necessary to stimulate menstruation. In the early 1980s researchers came up with a longer-lasting preparation - a gelatin capsule containing 200 mg of micronized progesterone suspended in oil.

A version of that product called Utrogestan, which is produced by the French pharmaceutical house Besins-Iscovesco, is now widely used for HRT in Mexico and Europe. Schering-Plough Corporation licensed micronized progesterone from LaSalle Laboratories, an affiliate of the French company, and supplied it in 200-mg capsules for the PEPI trial.

Schering plans to market that drug as Prometrium in the U.S., but doctors won’t be able to prescribe it for HRT until it is approved by the FDA for treating secondary amenorrhea, as many of the progestins were originally.



Richard

Rebecca Prescott asked:


Womens’ ovaries make two hormones - estrogen and progesterone. An easy way to remember what progesterone does is to break the word down. Pro (for), and gesterone (pregnancy/gestation) - it supports pregnancy.

Progesterone is a progestogen. Progestogens are a group of hormones which work in a similar way to progesterone - but only progesterone itself is natural. All the others in this group are synthetic. If progesterone is taken in the form of medication by mouth, the liver quickly breaks it down.

In 1934 a synthetic form was created to get round this problem. There are now over 10 synthetic progesterones available. The newest is a micronized version. Micronized means that the progesterone has been broken down into microscopic particles and avoids breakdown by the liver.

What Are Progestogens Used For?

If a woman has a condition which leads to her ovaries failing to work, natural progesterone won’t be made in sufficient quantities. Progestogens can be given to take their place. They can also help to treat abnormal bleeding from the uterus, PMS and in conjunction with HRT. They are probably best known for their use in birth control pills.

The Use Of Progestogens In HRT

Hormone Replacement Therapy (HRT) is recommended for women going through menopause or for those who have suffered damage to their ovaries. However, it is a controversial issue. The use of HRT implies that the fall in estrogen during menopause is a deficiency but menopause is a naturally occurring condition. It may actually be helping to protect the body.

For instance, it is known that estrogen can help the growth of certain breast cancers. Breast cancer is more prevalent in women around menopause age. So having a lower amount of estrogen in the bloodstream could be the body’s own protection against breast cancer.

At one time, the media portrayed HRT as a necessary wonder-drug but evidence regarding its true benefits and safety is conflicting. However, many women have flourished on it.

HRT contains estrogen and if you have not had a hysterectomy (removal of the uterus) it will also contain progesterone. This is because estrogen supplements given on their own can trigger uterine cancer but if a progestogen is given with it, that risk is virtually eliminated.

Estrogen is able to lower the risk of heart disease by increasing HDL (a ‘good’ cholesterol) but synthetic progestogens seem to lower this benefit - with the exception of the new, micronized form.

Progesterone and PMS

Pre Menstrual Syndrome (PMS) can make life a misery. It is thought that PMS is caused either by a lack of progesterone, the actual drop of progesterone levels or by the fluctuating ratio of progesterone to estrogen.

Both natural and synthetic progesterones can be used in an effort to treat PMS. Natural progesterone is chemically processed from yams. It’s given by suppositories (vaginal or rectal) or in the form of an injection. This is because it won’t absorb if taken by mouth - so avoid any ‘non-prescription’ remedies containing extracts of wild or Mexican yam. It’s physically impossible for them to work if swallowed.

Progestogens have been regularly prescribed for the treatment of PMS for the last 35 years. However, the British Medical Association still does not officially recommend them as the majority of studies have not found progesterone to have any meaningful affect. Nevertheless, many women claim that it has helped them.

Side Effects Of Progestogens

Don’t use if you have ever had blood clots in your legs or liver disease. Don’t take in pregnancy unless continually monitored by a doctor. It may also cause bloating, tender breasts, weight gain, headache, moodiness and irregular vaginal bleeding.

Maya