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Controversies about Menopause (2 of 2)

Let’s be clear, I will never be in favour of Hormone Replacement Therapy (HRT) given in pill form and supplying a fixed combination of non-human oestrogens (equine oestrogens) and synthetic progesterone. The mere presence of artificial progesterone, even if it is coupled to a bio-identical œstradiol, for me condemns this type of preparation due to the risk of cancer (breast).

To make matters worse, Tibolone is often prescribed in a single daily standardised dosage to relieve menopausal symptoms and protect bone density. This synthetic steroid has undoubted carcinogenic effects that have been the subject of several publications. Considering the well documented and known risks, Tibolone should be withdrawn from the market!

So, what do we do to help women complaining of insomnia due to hot flashes, vaginal dryness, low mood, or failing memory since their menopause? A possibility to alleviate their symptoms does exist without exposing them to unnecessary risks through the restoration of physiological hormonal values both of œstradiol and progesterone, as long as we have had the opportunity to measure their relative levels via evaluating their blood work.

This more natural approach is only for women complaining of symptoms typical of the menopause and who have no – or too low – hormone levels post-menopause.  Among the indications for such a treatment (let us all agree not to call it HRT given the pejorative connotations associated with this term!), one must add established osteoporosis. There again, one should rather consider the age of the patient (Z-score of bone density) rather than the absolute value (T-Score), which is too often put forward to frighten patients and, perhaps, used to encourage them to take the maligned biphosphonates…

Mucosal lubrication during the menopause constitutes a major indication for the physiological correction of the two sex hormones. Affected women readily mention vaginal dryness, or sometimes a problem with dry eyes. One should also add recurrent cystitis, that is sometimes more inflammatory than infectious, along with the lack of lubrication of the intestinal mucosa. This easily leads to malabsorption of nutrients (especially fat-soluble vitamins), or to a significant weakening of the intestinal mucosa synonymous with leaky gut syndrome (increased intestinal permeability).

We can see that many women would benefit from these corrective treatments but most are now terrorized by the mere mention of hormone therapy. We need to defuse the situation by explaining exactly what it is, and that is precisely the purpose of this article: there are excellent ways to avoid the pitfalls of conventional HRT…

The oral route should be avoided to avert what we call the first pass (directly from the intestine to the liver via the portal vein), hence the preference for a gel or a patch. However, gel holds the advantage over the patch, as it can be administered in such a way to give a boost in the morning (œstradiol) and the slowdown effect in the evening (progesterone). In all cases, dosage must be carefully adjusted on an individual basis according to blood tests: initial requirements are determined by baseline blood levels, and if they prove low, then the dosage can be initiated little by little. We must take into account possible side effects (warranting an immediate reduction in the dosage) and insist on blood tests being conducted after a few months, which will ultimately help to identify the optimal dosages suitable for each patient.

Such treatments that respect physiology, regardless of patient age, need not be limited in time, in contrast to conventional HRT. Women can benefit from this treatment for as long as necessary!

By changing nothing, we hang to what we understand, even if it is the bars of our own jail.
- John le Carré, The Russia House 1989

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