Questions and Answers
About Getting Off HRT and Onto
By John R. Lee, M.D. and Virginia Hopkins
What You Need to Know About Starting Bioidentical Hormone Therapy (BHRT)
How to have balanced hormones, and relief from menopausal symptoms, without
using conventional HRT!
The Women s Health Initiative (WHI) study was canceled because of a high
risk of breast cancer, heart disease and stroke associated with using HRT (hormone replacement
therapy). The study analyzed the health of 16,000 women aged 50 to 79 years. After five years,
those using HRT (Premarin and Provera or PremPro) had a 29 percent higher risk of breast cancer, a
26 percent higher risk of heart disease, and a 41 percent higher risk of stroke.
To personalize these numbers a bit more, of the 6 million women who are using
PremPro, this translates to approximately 4,200 women who got breast cancer, 4,800 women who got
heart disease, and 10,800 women who had a stroke in a five-year period because they were taking
this form of HRT. If we extend these numbers out over a decade, nearly 40,000 women were harmed by
taking these drugs. That s an epidemic, and doesn t include all the women who suffered
from weight gain, fatigue, depression, irritability, headaches, insomnia, bloating, low thyroid,
low libido, and gallbladder disease and blood clots
One of the most disturbing aspects of this scenario is that it was created due
to the carelessness of conventional medical practice, which dictated – without good supporting
evidence of safety and efficacy – that any woman over 50 complaining about anything remotely
related to menopause, be put on HRT. Their hormones weren t measured to find out which ones
they needed or how much, and they were subjected to a one-dose-fits-all mindset that created
overdoses of estrogen for millions of women. Furthermore, the efficacy of progesterone in hormone
replacement has been totally ignored in favor of the patentable (and therefore more profitable)
synthetic counterparts known as progestins.
To readers of my books and newsletters, the risks and side effects of
conventional HRT are not news – the evidence of harm has been showing up in research for at
least a decade. This particular study was finally large and prestigious enough that conventional
medicine was forced to pay attention.
Questions and Answers About Natural Hormone Replacement Therapy
Q: Do the results of the WHI apply to your recommendations
of using natural estrogen and progesterone ?
A: Not at all. What I recommend is first measuring saliva hormone levels to find if
there is a hormonal imbalance. Then, if necessary, correcting the imbalance using natural hormones
in physiologic doses, which means ordinary doses that the body would naturally produce itself.
(Please read one of our "What You Doctor May Not Tell
You..." books for details.)
Another way to look at this is, from puberty until menopause, a healthy
woman's body is making its own natural hormones in synchrony and balance, without giving her
cancer, heart disease or strokes. What I recommend is attempting to regain this natural balance as
closely as possible.
Conventional HRT not only fails to measure hormones and use physiologic doses,
it uses synthetic, not-found-in-nature “hormones” that are foreign to the human body and
cause a long list of unwanted side effects.
Q: How Do I Get Off PremPro?
A: Most women simply need to lower their dose of estrogen and replace the progestin
(the “pro” part of the PremPro) with progesterone cream.
Estrogen is a prescription-only medication in the U.S., so you ll need to
ask your doctor for a separate prescription for estrogen, preferably either estradiol, or a
combination of estradiol and estriol, or estriol alone (please read our breast cancer book for
details on using estriol). Even Premarin, although ethically objectionable in the way it is
obtained from pregnant mares, will work if it is used in the lowest dose needed, and in combination
with natural progesterone. If you discontinue estrogen suddenly, you re likely to suffer from
hot flashes and night sweats. Hot flashes and night sweats are less likely if the estrogen dose is
decreased in gradual steps.
Unless your doctor already has you on a low dose of estrogen, you can begin with
half the dose you have been taking when you add progesterone cream in place of the progestin. Many
menopausal women don t need any estrogen at all, and can gradually taper (over 3-4 months)
their dose down to nothing. Although transdermal progesterone alone will alleviate menopausal
symptoms for many women some women may need a little bit of estrogen to control their symptoms.
Symptoms of estrogen deficiency include hot flashes, night sweats, and vaginal dryness. Again, you
can find more specific information in our books.
Q: My doctor says that I can t use estrogen and progesterone cream, because
progesterone cream won t protect my uterus the way the progestins do.
A: Progesterone cream protects the uterus just fine. Not only did I not have any
problems in my hundreds of menopausal patients before I retired from practice, I am in touch with
dozens of physicians who have thousands of patients between them, who have never had a problem
(some of them have been doing this for over a decade). Furthermore, soon-to-be published
double-blind, placebo-controlled study by Helen Leonetti, M.D., proves that progesterone cream
protects just fine. Her study compared the uterine protection of PremPro with an
estrogen/progesterone cream combination. In short, the women on the progesterone cream came out
You might also ask your doctor how he thinks that your premenopausal body
protected itself against estrogen effects! It was the progesterone that your ovaries made every
Q: My doctor says that because blood tests don t
show a rise in progesterone when progesterone cream
is used, that it doesn t work, and I should use oral
A: Blood tests only measure the serum, which is the watery part of the blood, and
progesterone that comes from cream use is carried in the red blood cells, not in the serum. The
most accurate way to measure hormone levels is with a saliva hormone level test, which measures
your active or bioavailable hormones. When you use progesterone cream, a saliva hormone test will
show a gradual rise in hormone over a three-hour period, and then it reaches a plateau for several
hours and then gradually drops such that 90-% is gone after 15 hours. This amount of time is an
average, and can vary a bit from woman to woman.
Q: I read an article in a major magazine where a
doctor is quoted as saying that natural progesterone stimulates tissue growth in the breast and
therefore could contribute to breast cancer. Is this true?
A: We have tracked down the source of this
information, and once again, it was a progestin, not progesterone, that stimulated the cell growth
in the study being referred to. As you'll read in our books, progesterone stimulates cells to grow
toward differentiation, which is an anti-cancer property. Cancer cells are undifferentiated, and
thus grow without control. Progesterone also encourages cells to die when they're supposed to
(which cancer cells don't do). This topic is covered in detail in What Your Doctor May Not Tell
You About Breast Cancer.
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