Hormone Replacement Therapy [video]

Video author: Streaming Well
Doctors: To translate this video's captions for your patients, contact us here.

Video Transcript
Hormone Replacement Therapy

Dr Anu Arasu: Hi, I'm Dr Anu and today I'm going to talk about hormone replacement therapy. HRT is a really big topic for woman going through the menopause because they're probably having really disabling symptoms of hot flashes, night sweats, low mood, and irritability. Hormone replacement therapy can be amazing at reducing all of those symptoms plus just increasing energy, motivation, youthful appearance, and protecting the bones and the gut. So, we already know quite a lot about HRT because it's been in the media for all of it's risks, but what do you really need to know?

First of all, there are 2 types of HRT. There is the synthetic type, which is the common type that's been in the media and all the studies have been done on. And then there's something quite new called bioidentical hormone replacement therapy, and I'm going to come on and talk a bit about that later. So, HRT received a lot of bad press in 2002 and 2004 after there were 2 big studies, one in America called the Women's Health Initiative, and 1 in the UK called the Million Women Study, in which synthetic estrogen and progestin were looked at, and they were found to cause an increased risk of breast cancer.

Now, obviously this was quite a scare. Quite rightly clinicians all over the world said, "Hang on, we just need to interpret these studies with a bit of caution. "At the moment, only one type of synthetic hormones have been looked at, "we've only looked at one dose, and one way at giving these medicines. Would it be different if we looked at a different type, and if we gave it in a different way?" And that's a really sensible question because what we know about hormones is that their structure affects how our body's cells respond to them. What we also know is that taking a pill of estrogen isn't the same as using an estrogen cream. If you take a pill of estrogen it has to be processed by your liver, and that produces proteins like CRP, which are found in other diseases like heart disease. If you use estrogen through a cream it doesn't get processed by the liver. It has a different affect.

So, this has been a really interesting topic that was raised, and following on from that, there have been some studies to look at the 2 differences—the synthetic hormones in one group and the bioidentical hormones in another group. There's a French study that had to look at estrogen and progestin, the synthetic one, and looked at estrogen given with progesterone, the bioidentical one. What that study found was that the estrogen with the progestin caused an increased risk of cancer, but the estrogen with the progesterone didn't.

Now there have been some other studies that have also shown that natural or bioidentical progesterone has a different effect from synthetic progestin. This is an area that needs more research. This is all ongoing, but it's really interesting, and as a result, there have been lots of women internationally who have just said, "You know what? I only want to put hormones in my body that are bioidentical, i.e. identical in structure, to the ones that my body is making.' Enter the world of bioidentical hormone replacement. Here the chemicals are actually extracted from yam and soy, and they are designed to be identical to ones that our body produces.

They're so identical that if you measure the blood tests, you can't distinguish between the ones that have been given and the ones that the body produces. So, I just think it's a really important point to bear in mind when you are thinking about HRT to have a think about the benefits and risks but also to understand that there are 2 types of HRT and the big studies are only referring to the synthetic type. So, if you want to investigate the bioidentical hormone side then it would be worth you speaking to a specalist in that area. I hope this has been useful. I really look forward to hearing your comments.

Streaming Well