Hormone Replacement Therapy -
Worth the Risk?

Should you use hormone replacement therapy (HRT)? That is the question for many women approaching menopause. The decision has become more complicated in light of new research that shows that even though estrogen lowers cholesterol, it doesn't necessarily protect coronary arteries.

Preliminary results of a major long-term study suggest that HRT in post-menopausal women may actually increase chances for stroke or heart attack. This is from a study called the Women's Health Initiative conducted by the National Heart, Lung and Blood Institute in Bethesda, MD.

Circulating estrogen has long been touted as protecting the heart from heart disease. But, estrogen dramatically increases the risk of endometrial (the lining of the uterus) cancer. It was discovered that adding progesterone can counteract the danger of uterine cancer. Estrogen also increases the risk of breast cancer. Now it appears that progesterone can increase the risk of breast cancer also (Journal of the American Medical Association, Jan. 26, 2000). Doctors point out that heart disease kills more women per year than breast cancer.

But if, as scientists now suspect, estrogen does not prevent heart disease, then the benefit-risk ratio changes significantly. The Estrogen Replacement and Atherosclerosis (ERA) study just out demonstrates that neither Premarin (estrogen) or Prempo (estrogen plus progesterone) is better than a placebo at preventing plaque from building up in coronary arteries. This new information creates confusion for women.

Research is being carried out all the time on the effects of hormone replacement therapy, so that new findings are reported every few months. A woman and her practitioner need to assess the pros and cons of HRT. Now more than ever, each woman's individual medical history, risks and fears must be considered.

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What about Alternatives to Hormone Replacement Therapy?

Some women can't or don't want to take hormones. Traditional Chinese Medicine (TCM), which includes acupuncture and Chinese herbs, excels at reducing the menopausal symptoms.

First of all, menopause is not a disease. It is not an estrogen deficiency syndrome that needs to be "cured" with hormone replacement therapy. It is a normal, natural process that every woman goes through as she ages. According to western medicine, the symptoms of menopause are caused by changes in estrogen levels. As the ovaries become less functional, they produce less estrogen and the body subsequently reacts. The symptoms can range from mild to fairly severe. This variation is normal.

Some women may sail through menopause without difficulty. Others may experience such symptoms as hot flashes, night sweats, insomnia, fatigue, palpitations, depression, anxiety, memory loss, vaginal dryness and thinning, changes in libido (sex drive), irregular menstrual bleeding and the beginning stages of osteoporosis (bone thinning).

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Side Effects of Hormone Replacement Therapy

Hormone replacement therapy can reduce the undesirable symptoms of menopause, but HRT is fraught with side effects that can range from vaginal bleeding, breast tenderness, nausea, vomiting, abdominal bloating and uterine cramps to irritability and headaches. HRT can also increase the risk of breast and uterine cancer as mentioned previously, as well as increase the risk of gallbladder dysfunction, gallstones and high blood pressure. Sometimes a woman's menopausal symptoms are so severe and distressing that she may opt for HRT.

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Chinese Medicine Approach to Menopause

Whether a woman decides to take hormone replacement therapy or not, she can still benefit from Traditional Chinese Medicine. The World Health Organization (WHO), the medical branch of the UN, includes menopause among the many conditions that respond favorably to TCM.

As a woman ages, the Chinese medical perspective believes that menopausal symptoms (if any), are due to a decline in the Qi (pronounced "chee") or energy and the essence of the kidney. The kidney essence performs many functions, including overseeing re-production. It is the basis of our hereditary constitution; it determines energy, drive and strength; influences our resistance and is the foundation for the immune system. It also promotes the development of bone marrow.

There can be many other variations of patterns that can accompany the basic diminishing of kidney function. Acupuncture and Chinese herbs are beneficial in strengthening or "tonifying" the kidneys, as well as addressing the other patterns that may be present.

Chinese medicine, with its gentle and steady tonification of the kidney essence without side effects, can offer a safe and effective alternative to HRT, even though its effects aren't as rapid as the "quick fix" of hormone replacement therapy. If need be, acupuncture and Chinese herbs may be combined with HRT, because they work in different ways. HRT works by "tricking" the body into thinking that it is still ovulating, but it doesn't tonify the kidneys. Chinese medicine, on the other hand, gently tonifies the kidney and kidney essence to help a woman in this transitional time of life.

In addition to acupuncture and herbs, we may also recommend changes in diet and lifestyle. There are a myriad of things a woman can do for herself to lessen menopausal symptoms. Of course, prevention is key for so many conditions.

You can greatly reduce the possibility of suffering through menopause by establishing sound health habits early in life. Those health practices, along with Chinese medicine, can play a role in helping ease you through menopause. We advise women to gather as much information as they can so that they can make an educated decision regarding their approach to menopause.

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SAN FRANCISCO NATURAL MEDICINE
formerly: SOMA Acupuncture & Natural Health Clinic
Carl Hangee-Bauer, ND, LAc
Erika Horowitz, ND • Andrea Zengion, ND, LAc • Natalie Metz, ND
Jacqueline Blakely, ND, LAc • Nafysa Parpia, ND • Stephen Meeneghan, ND, LAc
1615 20th St • San Francisco CA 94107 • 415-643-6600

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