Dr. Sheila Dunn-Merritt

HRT — What should I do now?

Sound Consumer | August 2002

by Dr. Sheila Dunn-Merritt, N.D.

Since the landmark study investigating long-term Hormone Replacement Therapy (HRT) on menopausal women was stopped abruptly, my office has been flooded with calls from concerned women. The research making headlines cites, "significant health risks with HRT, including breast cancer, stroke, heart attack, and blood clots."

The synthetic hormones, Premarin and Provera, once believed by the medical community to be "the gold standard" for treating menopause, finally have been shown scientifically to produce these serious side effects, outweighing the possible benefits. The study spanned nine years and involved 16,000 women.

Concerned women are asking questions such as, "What should I do now? Should I go off all HRT "cold turkey? Is the natural HRT-triest and micronized progesterone safer?"

For those of you taking HRT, the answer is: there is no 'one-size-fits-all' solution. Each woman has a unique profile, yet mainstream medicine suggests that basically the entire menopausal population of women needs to take HRT. The pharmaceutical industry has a lot of influence, too, since six to eight million women currently are taking HRT, with annual revenues estimated in the billions of dollars.

For many years, naturopathic physicians have assumed that use of the synthetic hormones may have serious health risks. Instead, we have offered a wide array of effective alternative treatments for our patients' menopausal symptoms, including hot flashes, night sweats, insomnia, fatigue, mood swings, depression, and weight gain.

Most important, we recognize that since each woman is unique, the symptoms of menopause and her response to various treatments, whether they are pharmaceutical, botanical, or nutritional, will vary as well.

Here's an overview of what I believe to be a sensible strategy to address some of your health concerns about menopause.

  1. Explore your personal biology and genetics to determine your personal needs. As naturopathic physicians, we take into account your specific set of symptoms, your particular lifestyle and diet, as well as the environment you work and live in.
  2. Determine your personal risk factors for heart disease and osteoporosis. There are numerous ways to evaluate this:
    • Blood testing for cardiovascular risk
    • Dexa scan for bone density (hip and low back is best)
    • Evaluation of bone resorption through urinalysis
    • Genetic testing is inexpensive and recently available to determine your predisposition for osteoporosis and heart disease.
  3. Get a comprehensive baseline assessment of your hormone levels. This includes estradiol, estrone, estriol, progesterone, testosterone, and DHEA. It may be helpful to examine thyroid levels as well.
  4. Consider restoring the adrenal glands if fatigue is significant. An "Adrenal Profile" will assess your levels of DHEA and Cortisol. DHEA is the hormone that's naturally converted into estrogen, progesterone, testosterone, and cortisol, and is a hormone related to stress and blood sugar balance. This is a great evaluation for women who prefer to avoid HRT. I call it "treating the symptoms of menopause through the back door."
  5. Find out if you are at greater risk for breast cancer by taking a test to determine if you have a high level of 16 hydroxysestrone.

These guidelines are the first step in the process. Discover your personal risk factors and then we can choose from a whole spectrum of treatment options. The good news is that there's a wealth of information about natural, safe, effective therapies for the symptoms of menopause.

Let's embrace this as an opportunity to become more proactive with our health and become partners with our doctors in our quest for optimal health. And remember, once you implement a satisfactory treatment plan, revisit it at regular intervals to keep it current and effective.

Look for more on the treatments available in the September Sound Consumer.

Dr. Sheila Dunn-Merritt is a naturopath, homeopath, educator and author and has lectured widely on women's health issues. A Bastyr University graduate, she enjoys working with patients as a primary care physician in Bellevue. Her first book, "Treating Osteoporosis," is available at Primapub.com.

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