Thank you for your interest in the Ändlös Institute of Preventative Care. I am Dr. Robert G Carlson, MD, and a board certified General surgeon; board certified thoracic surgeon (heart and lung surgery) and a board certified physician in Anti-Aging Medicine through the American Academy of Anti-Aging Medicine.

My interest and experience in hormone replacement therapies began through the American Academy of Anti-aging medicine and by following over 6000 patients across the country in association with an internet based company. After Suzanne Somers graciously cited me in her amazing book “Ageless”, the development of my Age Management practice in Sarasota, Florida has expanded.

My philosophy is to provide the best care of patients, as I do with my heart patients, by empowering patients with knowledge so they can help themselves get better with my direction. Bioidentical Hormone replacement therapies in ladies have been wrought with controversies stirred up by continuing inaccurate information. I believe ladies should understand the true information of which I hope to provide in this lengthy, but informative presentation, and not be misled by individuals/physicians who lack the knowledge base.

I was recently amused by a section on Good Morning American, where Dr Tim Johnson was describing a recent study supporting the incredible long-term benefits of testosterone therapy in men. In completing, the presentation he chided that caution should be displayed as woman consumers were “burned” by estrogen replacement therapy in the past. He did not try to discern the difference between the safe bioidentical hormones, and the use of horse urine derived Premarin, and synthetic progestins.

These comments confuse the public, and doctors.

What I would like to do is empower you with accurate, medical-literature supported information, and allow you to make an educated decision. I also believe it is critical that patients should have the ability to adjust their medications daily as needed. I provide guidance to this philosophy, but each lady is an individual.

No two ladies hormonal issues are the same. And importantly the changes of daily stress will also affect her hormonal needs. Besides, whom more then her should know about these issues and make the appropriate and important adjustments.

Through Andlos Institute, proper hormonal management is all about empowering the patient with knowledge, and guiding ladies to help them feel the best they can.

I would like to share with you the information that I have gained through my journey in the field of bioidentical hormone replacement therapy. I would like to review the data on both the synthetic and the bioidentical hormone replacement therapies.

One of the most quoted studies was the Women’s Health Initiative Study that identified significant cancer risks associated with “hormone replacement therapy” using Premarin (horse urine estrogen) and progestins or synthetic progesterone. Many ladies intelligently abandoned the use of these medications and began looking for help.

Suzanne Somers wrote “The Sexy Years” in the 90’s, which describes her trials and tribulations encountered when looking for help in dealing with her menopausal symptoms. Most of her early attempts with physicians resulted in comments like: “that’s what happens when you get older.” or “just tough it out and it will get better.” Suzanne didn’t accept that approach and searched out physicians who specialize in bioidentical hormone replacement therapy. A therapy, which avoided the dangerous pharmaceutical “hormone replacement therapy”, drugs, and used compounded identical hormones that biologically are identical to the same hormones that exist in your body.

Sounds logical, and safe, but the problem was that the big pharmaceutical companies began losing millions of dollars. Common business practice is to slander your competitions product and confuse the consumers and prescribing physicians. It takes lots of money, but then they have lots of money, and they were losing lots of money.

I feel that the use of bioidentical hormone therapy for ladies has two phases, It is not only important in controlling the symptoms of menopause, but critical in protecting ladies from the ravages of aging by reducing the development of osteoporosis and its devastating consequences. Secondly, by also protecting ladies from heart disease, since 45 % of the women over 55 die from heart disease, and is the number one killer of women, and thirdly reducing the incidence of cancer, with an over 40% reduction in colon cancer using proper hormone replacement.

With each passing year, our organs produce fewer hormones, notable from age 25 onwards, with a decline in almost all hormones. This is a slow a steady decline, but also the receptors that receive this hormonal signal throughout the body begin to disappear.

Should we be without hormones when symptoms might span a great deal of time, when progesterone deficiency causing anxiety and PMS might extend over a 10 to 15 year span prior to menopause? Maybe 75 % of women might experience hot flashes for a short period of time, but the other 25 % experience hot flashes that go on and on. Testosterone deficiency in ladies parallels the loss of estrogen and will result in decreased energy, loss of feeling of well-being, and loss of libido. The cessation of menses and menopause occurs on the average of age 51.

Data shows that there are receptors (or receiving stations) for estrogen, progesterone, and testosterone in every organ in the body, in the brain, bone, kidney, liver, skin, hair follicles, muscles, and even the heart. The concentration of testosterone receptors is higher in the heart than any other organ.

It’s no wonder that hormone deficiency causes a host of symptoms including, hot flashes, dryness, sleep disturbances, lack of motivation, depression, declines in energy and stamina. And then come the degenerative diseases that follow from organ deterioration as time goes on: osteoporosis, colon cancer, heart disease…… safe is that?

Progesterone is the first to go, producing a host of symptoms, like lighter sleep, mood swings, heavier bleeding, worse PMS, mid-abdominal weight gain. This is one of the deficiencies that are most commonly misdiagnosed. The number of women in their late thirties or early forties that are being treated with Ambien™ to help sleep, Xanax™ for anxiety and Elavil™ for depression are staggering. The resultant “zombie” state exists when all that is needed is proper attention to the progesterone deficiency, and not treating a supposed ambient or xanax deficiency.

The level of standard of care is when you have a deficiency in Cortisol or adrenal fatigue; you treat it with bioidentical Cortisol. When you have a deficiency in thyroid hormone, you treat that with thyroid hormone replacement therapy. When you have an insulin deficiency and the development of diabetes, you treat that initially with oral medications, then with insulin replacement. The reason we treat these deficiencies is that the short-term and long- term deficiencies result in significant damage to your body.

So why are we so confused about sex hormone replacement? Especially when we know that, there are receptors for these hormones throughout our body. There must be a reason why we have these receptors throughout our body. They must be very important. And they are. I believe it would be reasonable to say that we should not be without our hormones, not just in perimenopause or menopause, but not ever..

Important issues that have raised considerable concern about hormone replacement therapy are heart disease and cancer. One of the first studies that are important in defining the relationship of hormone replacement and cancer is the Women’s Health Initiative study. This study uses synthetic estrogen or conjugated equine estrogen known as Premarin, and synthetic progestins called Provera. There is nothing natural, nor bioidentical about these medications.

This was a study of 16,000 women, but very important in this study is that the average age of the patient is 63 years, and in the Memory study the average age of 71. The data that they got for the equine estrogen/synthetic progesterone for 10,000 women demonstrated 7 more heart attacks, 18 more clots, 8 more strokes, 8 more breast cancers, 6 fewer colon cancers, 6 fewer hip fractures. It was the first study to actually demonstrate a reduction in hip fractures, and not just an increase in bone density, and 97.5 % of the women had did not have any adverse events. The relative risks were in the 1 to 2 range.

A few years later, the data on the patients only receiving Premarin was published. Early results actually demonstrated a significant decrease in coronary artery disease and breast cancer, and these results supported the concern that it was the progestins or synthetic progesterone which actually caused the increased coronary artery disease and breast cancer.

Some of the large trials such as the Nurses Health Study and the Breast Cancer Demonstration Project supported the concern for Progestins. As far as what was wrong with the WHI, is that there was a component of irresponsible reporting especially when the positive results of the Estrogen only group weren’t covered. But more importantly from a clinical standpoint, the WHI study started with a group of ladies with a higher level of preexisting disease( average age= 63 years), and the oral route has increased inflammatory issues(higher CRP and homocysteine) as well as higher weight gains versus the topical approach. The synthetic hormones administered after metabolism result in the wrong ratios, as far as being a protective ratio.

What are the proper ratios? The premenopausal ratios were initially described by Dr. Jonathan Wright in 1988, and Estrone to Estradiol to Estriol were 10% Estrone being the clot and breast stimulating estrogen, 10 % Estradiol which is more biologically active and protects the heart and blood vessels, and Estriol which is clot and breast protective at 80 %.

At menopause, the Estrone becomes the predominant estrogen being formed primarily in the adrenal gland and the fat tissue. The incidence of Breast cancer is predominantly postmenopausal representing an occurrence of over 80% versus 20 % premenopausal. There are higher concentrations of Estrone, being produced in the fat tissue of the breast. The higher incidence of Breast cancer postmenopausal is certainly related to these high Estrone concentrations in the breast tissue as well as the 16-OH pathway of Estrone metabolism. The Estradiol and the Estriol progressively decrease postmenopausal because they are produced primarily in the ovaries. The WHI used Premarin, a conjugated Equine Estrogen and the profile of Premarin is 50% Estrone, ½ % of the Estradiol, No Estriol and approximately 40 % Horse Equilin, which is of course in no way bioidentical to the body.

Bioidentical hormones have been used for a long time around the world. Once they were considered natural, but a better terminology would be human identical or bioequivalent. They mimic nature by being exactly molecularly equivalent to our natural hormone. They fit like a hand in a glove. The sit on a receptor only briefly, versus Premarin which may bind a receptor for up to 2 weeks. They are compounded from Soy and Yams, by cutting off all the extra molecules that are not equivalent to the human body, so that they fit the receptor exactly.

What we need to realize is that bioidentical hormones aren’t just made by compounding pharmacies. There are also patented Bioidentical hormones like Estrace ™, Climara™ , etc so what we have to realize is that the claims that bioidentical hormones are not backed by data, or FDA approved are really not true, because they are used in the pharmaceutical medications Estrace and Climara , and a whole host of other medications.

The problem for the pharmaceutical companies is that bioidentical hormones have been around for a long time, and thus all out of patent. The preparations that are now in patent with the big drug companies are based on their delivery systems for the hormone, and not the actual hormone. Also all these products only contain Estradiol, and not Estriol! This represents a mono-estrogen therapy and will not provide the proper protective balanced ratio of estrogen that has been identified as being very beneficial to a healthy cancer-free lifestyle.

There are also some patented bioidentical progesterone preparations, some in peanut oil, which in the allergic patient is seriously contraindicated. Ideally, it would be nice to provide all the bioidentical hormones needed into one preparation. Through compounding pharmacies, this preparation can be exactly prescribed to allow the optimal hormone balance for each individual patient.

If you look at the structure natural progesterone and synthetic progestins there is a significant difference in molecular structure with an additional molecule on the medroxyprogesterone (Progestin) that does not exist in the human body. Therefore, even though it may have progesterone type effects it doesn’t bind to the receptors as effectively as a human identical may or bioidentical progesterone, and we don’t naturally have the enzymes to break them down.

A careful examination of the literature in regards to the difference between natural progesterone and synthetic Progestins as used in the Women’s Health Initiative Study is very interesting. Bioidentical Progesterone is vastly different from the synthetic progestins (also used in Birth Control Pills). Women in the Mayo Clinic study preferred Bioidentical Progesterone, whereas the synthetic progestin caused weight gain, acne, and irritability. Bioidentical Progesterone improved mood, anxiety, depression and lessened vaginal bleeding and, better sleep (Menopause 2002). Ladies feel so much better when switched from synthetic Progestins to natural progesterone.

The cardiovascular risks are improved with use of natural progesterone in comparison to synthetic Progestins. Bioidentical Progesterone decreased LDL’s (JAMA 1995), inhibits vascular smooth muscle (Journal Vascular Surgery 2002). Whereas synthetic Progestins actually stimulated smooth muscle proliferation in coronary arteries. Bioidentical Progesterone vasodilates, increases nitric oxide, and does not increase C-Reactive protein. Whereas synthetic progestins oppose vasodilatation (Circulation 2001), and increases C – reactive protein (Circulation 1999). There is very strong data to support the use of bioidentical progesterone instead of the synthetic progestins ( Prempro™, Provera™).

The beneficial protective effects of Bioidentical Progesterone on the brain have been shown to be important and have shown dramatic improvement in closed head injuries as well. Bioidentical progesterone does stimulate bone formation, where synthetic progesterone does not have an inhibitory effect. It is quite clear that the bioidentical progesterone is the best choice.

Further evidence exists of the beneficial effects of Progesterone and Breast Cancer. Breast cancer is the number one fear expressed by women when discussing Hormone replacement therapy (HRT). This fear has been fueled by the newspaper headlines, which provide inaccurate and accusatory information to patients and to physicians about the problems associated with Hormone therapy.

To place this concern in proper perspective we need to understand that the 2-year mortality for hip fractures is much greater than the 10-year mortality for Breast cancer. There are 8X more osteoporosis related fractures than Breast Cancer, 6X more than stroke, 3X more than heart attacks, so fractures clearly causes tremendous disease burden and associated morbidity and mortality.

Numerous studies have been performed that examine the effects of estrogen and breast cancer. Unfortunately the information provided to patients neglects to discern between the three very distinct types of estrogen: Estrone, Estradiol, and Estriol, but instead refers to hormone replacement therapy as the use of synthetic estrogen or Premarin, and synthetic Progesterone or progestins, and not the naturally occurring bioidentical hormones of Progesterone and the three types of bioidentical estrogen.

A number of years ago, two big trials, the WHI study in the United States, and the Women’s Health Initiative Study of Lund, Sweden examined the relationship of hormone replacement therapy with synthetic hormones, and described that women on hormone replacement therapy had a higher incidence of Breast cancer. Importantly, the women in these studies who were only on Estrogen, and who did not receive the synthetic progestins, did not have any increase in Breast Cancer. The relative risk was 0.8(greater than 1 identifies an increased risk) in the women who just received the estrogen.

Another study, the Swiss HRT study examined 23,000 women that used mostly Estradiol or Estriol. 83 % of those women were either on Estradiol alone or the combination of Estradiol/Estriol.. This study demonstrated a 25 % reduction in breast cancer rate and an overall mortality, which was reduced in those women.

A study from MD Anderson Cancer Institute in Texas, looked at a study of 319 women who had localized breast cancer, and two years after the initial treatment when they were free of disease, they were started on estrogen alone. After 6 years, they found that there was no increase in the rate of recurrence, but in fact, there was less recurrence in the women in the estrogen group than in the placebo group.

A second study showed that the recurrence rate in the estrogen group after five years was 3.6 %, and in the non-estrogen group was 13.5 %. So in fact, estrogen not only does not increase the risk of recurrence, but also in fact reduces the recurrence rate.

The balance of the hormones is actually required to reduce the incidence and to protect ladies from Breast cancer. The studies that support this show that the risk ranges from reduced to 1.46. The 1.46 risk was a subgroup of ladies in the Nurses Health Study where these ladies drank more than three alcoholic beverages per day. Synthetic Progestins increase Breast Cancer.

There are four studies that support the association of Breast Cancer and Progestin use, including the WHI study that showed a two-fold increase in Breast Cancer when Progestins were added to the Estrogen regimen, Breast Cancer Demonstration Project that showed an 8-fold increase, the Swedish Record Review with a 2 ½ -fold increase and the Million Women study with a two-fold increase of Breast Cancer with the addition of synthetic Progestins to the Estrogen regimen. The association of Progestins and Breast Cancer are beginning to become quite well understood.

By using surgical breast biopsies, it was found that Oral conjugated equine estrogen regimens increase the epithelial mitotic index in the Breast, but even more when you add synthetic Progestins to the regimens.

A Journal of Cancer Institute article (2000) described adding Progestins to a hormonal regimen increased the incidence of Breast cancer by 29% over baseline (review article)

If we really thought that hormone replacement therapy causes Breast Cancer, than we would expect a recurrence rate of Breast Cancer to increase in patients who already had Breast Cancer, but nine independent studies have not shown this fact. These results were collected from five different countries, and the conclusions were that there was either no beneficial effect of hormone replacement therapy, or there was beneficial effects or that there was a decreased mortality. But there was a recent study, from Archives of Internal Medicine (July 2006), showing that combined conjugated estrogen and methylated testosterone(Estratest™) actually had a relative risk for Breast Cancer of 1.77, compared to Estrogen only.

Therefore, the addition of the methylated testosterone to the regimen increased the incidence of breast cancer (Analysis of Nurses Health Study). This synthetic Testosterone could indirectly affect the conversion of Estradiol and Estrone, thus increasing the Estrone concentrations. In addition, oral methyl-testosterone is metabolized in the liver and is processed to a host of compounds that maybe very unlike the profile that we expect.

An important component of estrogen metabolism has been examined and is called Estrogenomics. This process identifies patients who are at high risk for metabolizing Estrone to 16-OH Estrone, which is strongly associated with Breast, Colon, Uterine, and recently to ovarian cancer postmenopausally. Metabolic and Genetic examination of sister’s with Breast cancer have identified a significantly elevated metabolism of Estrone to 16-OH versus the 2-OH metabolite. Thus supporting the association of 16-OH Estrone with malignancies.

What about bioidentical hormones. Something that is critical to apply to our knowledge of hormone replacement therapy is common sense. If normal estrogen ratios in humans is carcinogenic to the breast, than why is 80 % of breast cancers postmenopausal. The time in a ladies life when estrogen levels are precipitously declining and there is significant hormonal imbalances.

In fact, a French study with 3000 women over nine years using Estradiol and progesterone showed a relative Breast Cancer risk of .98, or not significantly affected. Postmenopausally there is a role in Breast Cancer development for hormonal imbalance, too much Estrone (and its 16-OH metabolites), and too little Estriol. The natural balance of Estrogen is to have 10% of Estrone (E1), but the way that the Estrone is processed is critical.

If you have the proper methyl groups, if you have the proper enzymes, if your diet is high in cruciferous vegetables and I3C, or if you are overweight and smoke. Normally 99 % of the metabolism of Estrone will form a methylated breakdown product, which is cleared by the liver without any untoward effects. Unfortunately, 1% of it will be metabolized to either the 2-OH, 4-OH, or 16-OH Estrone. And it is that ratio that can make a difference because the 4-OH, and 16-OH forms are mutagenic, and DNA binding, High levels of 4-OH, and 16-OH have been found to be associated with Breast Cancer, and there have been some studies to show that compounds like I3C(found in cruciferous vegetables) and DIM, will favor the metabolism of the 2-OH pathway, and this literature is in the chemical research and toxicology journals.

The role of low Estriol is also very critical. Estriol has been shown to inhibit mammary carcinogens (Cancer Research 1975). In humans, low Estriol also contributes to the development of Breast Cancer. Women with Breast cancer often have low Estriol levels, and a recent report showed that Estriol reduced the metastatic recurrence of Breast Cancer by 37 %.( Cancer Research). One of the mechanisms involves the binding of Estriol to Beta Estrogen receptor, and may actually inhibit binding to the alpha-receptor. (2006)

Progesterone deficiency is critical because progesterone inhibits breast cell proliferation (British Journal of Cancer 1996). Whereas synthetic progestins however increases cell adhesion( Cancer Research 2002) The longest and the most compelling study published in 1981, involved 33 year follow-up on 700 women with progesterone deficiency who were being followed for infertility. They identified a 10-fold increase in risk of death from all cancers, and a 5.4 fold increase in premenopausal Breast cancer.

At the cellular level, progesterone reduces breast cell uptake of Estradiol. This is important, as the treatment of women who have undergone a hysterectomy with estrogen only replacement, have lost the protective effect of progesterone on the Breast, as well as the protective effect of the rest of the organs. This supports the philosophy that progesterone should always be used in women with a hysterectomy, and with low progesterone levels.

Toxins have been identified in our environment that acts on our bodies like estrogen. Some have been identified in meats, some from pesticides, petroleum products, make-up products, and alcohol. This could be associated with the issue of excess estrogen and the increasing existence of estrogen dominance. 22:57.

In regards to the association of fat, there are studies that less than 20 % fat intake are associated with improvement in Breast Cancer incidence, although Harvard’s Nurses Health Study did not show a link to fat, all of the women with malignancy had greater than 30 % fat intake. A recent article in Obesity September 2006, identified that exercise lowers the rate of Breast cancer, as well as other cancers. What they found is that women with a high body mass index and low physical activity had Estrone concentrations that were 55 % higher than women with low body index and high exercise activity.

There are obviously multiple factors associated with the development of Breast cancer, with 4% of Breast Cancers occurring with genetic predisposition, 30% of breast cancer occurs with women with a family history or other risk factors, so that almost 70% of Breast Cancers have no clear explanation for its development.

From the standpoint of the heart, the Journal of American Epidemiology 2002 published a study that identified if you hold onto your natural hormones longer that you will lower the risks of cardiovascular disease. The reason for that is that bioidentical estrogen vasodilates (Journal of Clinical Endocrinology and Metabolism), decreases sympathetic outflow, and decreases vascular proliferation (Circulation 2001).

Bioidentical Estrogen will lower blood pressure (Journal of Clinical Endocrinology 2006). This study identified a healthy estrogen ratio with an abundance of 2-OH Estrone versus 16-OH Estrone(associated with malignancies) is associated with a lower systolic blood pressure because 2-OH Estrone is a vascular smooth muscle inhibitor. Transdermal estrogen causes a significant reduction in blood pressure.

This data is not only very relevant, but also very important in the daily management of blood pressure in women. Often women are told to stop their Estrogen because their blood pressure is elevated. This is certainly the case with the synthetic progestin and the conjugated equine estrogen, but if you look at the bioidentical hormones administered, especially the transdermals there is a protective effect on blood pressure. In addition, the transdermals have a protective effect on thrombosis, as opposed to the synthetic preparations.

Transdermal Estradiol has a beneficial effect on fibrinogen, lowers the clotting and fibrinolytic pathways. The Mayo clinic study demonstrated a reduction in Calcium content and arterial plaques size with Estrogen therapy.

What about the results of the Women’s Health Initiative Study? In Menopause 2006, results have identified the benefit of starting women on replacement therapy earlier, and if you don’t use HRT that you will develop plaques. If therapy is started early then results demonstrate a reduction in the development of arterial plaques. If you use it late you may be at risk of rupturing already developed arterial plaques. Studies support this concept.

The WHI study and the HERS study; average age was 65 years, and 67 years respectively. All the women in the HERS study already had hypertension and coronary artery disease, and obviously they had an increased incidence of heart disease as well. However the Nurses Health Study, had an average age of 52 years, had no increased coronary artery disease. In addition, four large prospective trials that have been recently reviewed all demonstrated decreases when replacement therapy was started at the mean age of 53 years.

Early hormone replacement therapy is protective; it prevents arterial plaques and coronary arterial disease, but will not prevent or reduce already existing disease. Unfortunately, the data that may show that even late administration of Bioidentical hormone replacement is protective for the development of coronary artery disease has not been yet obtained or studied. The data for the use of late administration of the synthetic hormone replacement (conjugated equine estrogen/ and or progestins) does however exist and should not be used as a late therapy.

Synthetic progesterone or progestins are not good. The estrogen only arm identified a decreased risk of coronary artery disease, and that progestins decrease the cardio protective effect of estrogen. In animal models where ischemic injury was induced, or blood flow to the heart was stopped, the protective effect of estrogen, which was initially demonstrated, was lost when progestins were added to the therapy.

Synthetic progestins stimulate smooth muscle proliferation in coronary arteries and increase C- reactive protein, which is associated with arterial disease.

A recent review of the WHI study looking at the long-term effects in patients who only received Premarin, demonstrated no significant long-term benefit in regards to coronary artery disease, an increased stroke risk, and increased dementia in women only receiving Premarin.

One of the latest studies, that is presently ongoing and is without results at this time, decided to treat women in the earlier years of menopause with transdermal bioidentical estrogen with micronized or bioidentical progesterone. You can certainly understand that the massive pharmaceutical funding for this study is not present, as these therapies have all exceeded their patent limitations.

Benefits of bioidentical HRT on the Brain

The beneficial effects of Estradiol and Estriol on cerebral perfusion and cognition have been identified. There are estrogen and progesterone receptors all over the brain. Estrogen loss results in a decline in serotonin. When women in perimenopause/menopause come into the physician’s office depressed they don’t have an Elavil™ deficiency, they probably have a hormonal deficiency. Progesterone binds directly to the GABA receptors, just like Valium™, Ativan™, Ambien™ and Xanax™.

Estriol has been used successfully in autoimmune demyelination syndromes and multiple sclerosis. Estriol has a very strong effect in the brain, and actually, some reports have shown that Estriol may have a stronger effect in the brain than Estradiol and Estrone. Studies on the beneficial effects of hormone therapy on brain function show that short course and late start have no benefit to the brain.

In the WHI, late administration did not protect the brain, and in the Memory Study (average age 71 years) showed no beneficial effect, and maybe even a deleterious effect on cognition with increased dementia. Recent studies in regards to long-term follow-up in the estrogen only group from the WHI study demonstrated an increased incidence of dementia.

Short course, one year therapy of estrogen, in Alzheimer patients should no benefit, but if started early as in the Nurses Health Study it did demonstrate a benefit. Recent article in the New England Journal of Medicine, the review of the NAIMS trial concluded that hormone replacement therapy started immediately after menopause demonstrated a neuroprotective effect 20 years later.

The pathology of brain function and vascular blood flow to the brain probably has the same pathology as coronary artery disease and the heart. The Cash County study showed that the benefits required greater than 10 years, but that there was a five-fold decrease in memory changes. In Neurology 2001, High dose transdermal Estradiol was shown to improve cognition in women, both verbal memory and visual memory.

Recent pilot study with 428 women, showed that early HRT, less than 56, improved cognition, whereas late HRT maybe detrimental. Estradiol enhances prefrontal cognitive processes when functional MRI is used with a 43% reduction in cognitive preseverative errors, which was published in October 2006. Estradiol and testosterone enhanced brain activation when examined with a functional MRI and what was found was that there was an increased activation of the Limbic system was greater when Estradiol and testosterone were used together. (2006).

A recent study in the neuropsychology literature (2006), demonstrated that a higher Estradiol level resulted in better memory. Both measurement of episodic memory and verbal fluency were better in HRT users than in patients not receiving replacement therapy. Senile dementia in a JAMA meta-analysis was also reduced with Hormone replacement therapy. Even the synthetic estrogens, and as above the bioidentical estrogens if used early will have a beneficial protective effect on cognition.

Benefits of bioidentical HRT on Osteoporosis

Estradiol is critical in maintain bone structure and decreasing osteoclastic activity (pac-man like eating of bone) which destroys bone, but also important, and possibly more important for bone protection is progesterone and testosterone. Multiple studies have shown that synthetic estrogen will reduce bone loss, however bioidentical estradiol also prevents bone loss. Natural Progesterone builds bone, as opposed to estrogen that prevents bone loss.

Ladies who are evaluated in their early 50’s have already lost a lot of bone, because they have been with out a major bone builder (Progesterone) for 10 – 15 years. We should be screening ladies earlier for bone loss, instead of waiting until they are 50 years old. Testosterone will increase hip density, and bone mineral density, and is a big bone builder. Estrogen, Progesterone, and Testosterone all have bone effects and are critical to use in combination when they are low.

Benefits of Bioidentical HRT and Colon Cancer

There were six fewer colon cancers in the big WHI study using Premarin, but more importantly there has been a meta-analysis review of over 18 studies which concluded that Hormone Replacement Therapy reduced the occurrence of colorectal cancer by 34% versus women who did not use HRT.

Benefits of Bioidentical HRT and sexual function

There are numerous studies that show that testosterone in women will increase libido, and sexual function. On testosterone therapy, ladies describe a greater sense of well being and increased energy levels. Vaginal dryness is managed with vaginal Estriol or Estriol better than oral estrogen preparations. Estriol is very effective when used in women who demonstrate vaginal wall atrophy and thinning, and vaginal dryness resulting in discomfort associated with intercourse. In addition, vaginal dryness is related to increased incidence, as well as recurrence of urinary tract infections.

The data is very powerful and supports the philosophy that women should not be without their hormones. Ladies shouldn’t be without their hormones, because the evidence is there to support the use of bioidentical progesterone, of the beneficial protective effects of proper hormonal ratios on breast cancer, the protective cardiac effects, the protective effects on the brain when used in time to prevent disease, and the protective effect on the bone. The dramatic improvement in ladies who receive proper bioidentical hormone replacement therapy is impressive.

I believe there are two components of this therapy. Certainly, the first component is managing the vasomotor effects, depression, anxiety, sleep issues, and altered memory, but I believe even more important is the improvement in osteoporosis, and the beneficial effects of avoiding the complications of hip/back fractures associated with the ongoing process of osteoporosis.

Secondly are the beneficial cardiovascular effects of hormone replacement on the heart and blood vessels. Heart disease is the number one killer in women, representing 45 % of the deaths of women over the age of 55. Thirdly is the dramatic reduction in cancer, with a 40 % reduction in colon cancer and reduction in breast cancer with proper transdermal hormone replacement.