By Donna Walters and Blane Crandall, MD –
Forty years of observational studies have shown that improved quality of life and longevity are the benefits of replacing estrogen in postmenopausal women and young women with surgical menopause. These conclusions could not be drawn from double blind placebo-controlled studies and for the same reason that thyroid hormone, insulin and cortisone replacement have never been studied using that model. Giving a placebo instead of the real hormone for thyroid dysfunction or instead of insulin for diabetes is dangerous and illogical. Estrogen deficiency is just as dangerous as those other hormone deficiencies, it just happens slower. The decision to use insulin, thyroid replacement and cortisone replacement was based on observation and historical consequences of not taking them. Physicians, patients, friends, and family observe the consequences of not using estrogen in menopause. Excellent large observational studies confirm the findings of clinicians and family when women receive estrogen replacement.
Women that need or will need to replace their estrogen fall into four main categories:
Estrogen replacement should begin when the uterus and ovaries are removed in premenopausal and postmenopausal women and should continue for life.
Estrogen and cycled or continuous progestin or progesterone should be started at the time of removal of both ovaries in premenopausal women. The progesterone or progestin protects the lining of the uterus from endometrial cancer. This should be continued for life.
A young premenopausal woman who has had a hysterectomy without removal of the ovaries should start estrogen when her ovaries stop working and continue it for life.
At menopause, estrogen and cycled or continuous progestin or progesterone should be started and continued for life in a woman who has not had a hysterectomy.
These recommendations do not agree with those of the WHI (Women’s Health Initiative) because the WHI is wrong. The conclusions of the WHI were made with no apparent understanding of the natural history of the diseases discussed, the healthcare of women, or the pharmacology of the hormones used. This is a topic that is reviewed in depth in Dr. Blane Crandall’s book, “Estrogen Revisited, Lifelong and Fearless”. That discussion also includes other studies that will allow the reader to reach his or her own conclusions.
Physicians should treat estrogen deficiency with estrogen replacement.
Estrogen should be taken to alleviate estrogen deficiency. Progesterone or progestin is given to prevent endometrial cancer. These hormones should not be assumed to treat any other disease. Women who are estrogen deficient and do not take estrogen have a higher risk of heart attack, fractures, loss of height and spinal deformity, Alzheimer’s disease, death from breast cancer, developing and dying from colon cancer, and loss of independence.
Thyroid hormone replacement and estrogen replacement are very similar. If someone with thyroid deficiency does not take thyroid hormone replacement (Synthroid, for example), he or she will frequently eventually develop muscle edema and congestive heart failure. No physician would ever suggest prescribing a thyroid hormone replacement to treat congestive heart failure. The physician would replace the thyroid and treat the heart with heart medications, of course. Women should take estrogen and enjoy the benefits, but they should try to prevent and treat other diseases and deficiencies appropriately.
The WHI study was about horse estrogen taken orally and a progestin that, fortunately, few physicians prescribe use anymore. Dr. Crandall tells women every day that the study was done with he wrong hormone (horse estrogen) , the wrong delivery system (oral) and the wrong dosing .
The good News – The WHI isn’t about the way women are treated for menopause today. We have bio-identical hormones. Just like thyroid or insulin, the dosing can be monitored. There are many choices in the transdermal delivery systems that do no increase the incidence of blood clots in the legs.
The bad news – The conclusions of the WHI have changed the way many physicians treat hormone deficiency even though they were not valid AND the conclusions should not be extended to include all estrogen or all progesterone or all progestins. BUT package inserts for every estrogen prescription preparation includes the WHI warnings!
Read the Book!
Buy the book on Nook or get the Nook App for your iPad or computer. “Estrogen Revisited, Lifelong and Fearless” by Donna Walters and Blane Crandall, MD.
Call for an appointment.
1660 Medical Blvd. Suite 101, Naples, FL 34110