The Estrogen Dilemma

Cynthia Gomey of the NY Times explores the Estrogen Dilemma in her May 2010 article. In 2003, hormone replacement came to a screeching stop when the Women's Health Initiative (WHI) study showed an increase in heart disease, strokes and breast cancer in women using HRT.

Since then, the pendulum is swinging back towards HRT. One researcher's critique of the WHI study was summed up as "the wrong drugs on the wrong population". The WHI study looked at women 10-13 years past menopause. They also used synthetic hormones rather than bio-identical hormones.

Researchers are now studying something called the "timing hypothesis". To summarize, the body must have the right type of estrogen early, when it is still able to respond to the estrogen to make a difference. When estrogen is given to late, the body does not respond and more negative effects are seen. New studies are evaluating 40-60 year old women on HRT, their mood, their memory loss, & risk of heart disease and cancer.

As an Age Management physician, I have always believed that TIMING is everything. A disease process can take over ten years to occur. To prevent a disease, we must begin much earlier and understand how everything is connected.

Once the degenerative process has started, the body does not respond as well. I am a firm believer in HRT for the right people at the right time. Using the holistic approach to understand each individual's disease risk, can make a difference.

My evaluations are very thorough and provide women the much needed baseline for their health. During my evaluations, I review their risk of developing diabetes, heart disease, cancer and then make recommendations on how to improve these risk factors. There are many women who see me the first time and are not candidates for HRT due to their lifestyle. But as they improve their lifestyle, in six to nine months they are good candidates for HRT.

The other concern with HRT is how traditional medicine is practiced. The traditional physician may give you hormones but they do not monitor you to see if you have achieved the target levels, check to see what your risk for chronic disease is, and how you can improve your health. I strongly believe all women should be monitored while on hormones. There is not one medication given in a medical practice that is not monitored except for women's hormone replacement and birth control. We monitor men on testosterone, why don't we monitor women on estrogen replacement?

"Because women can just say they feel different and that's enough". That I find ridiculous as a physician and a woman. I tell my patients that I am going to treat them just like a man! My program is monitored and if you do not wish to be monitored, I don't prescribe hormones. There are risk and benefits to everything and as long as women are healthy, takecare of themselves, have no personal history of cancer, they are great candidates for hormone replacement. Women who have chronic disease will need further studies to understand what their risk for hormone replacement is.

My goal for my patients is always to achieve Optimal Health. Why settle for normal when you can be optimal!