The average woman will live until age seventy-eight, meaning that she will live one-third of her life after her menopause. Since thyroid disorders affect women so much more frequently, particularly as they age, balancing thyroid hormone replacement with the confusion surrounding traditional estrogen and progesterone hormone replacement is challenging. Since heart disease can be a major complication of hypothy-roidism or thyrotoxicosis, in the 1980s and 1990s, women with thyroid disease were encouraged to seriously consider hormone replacement therapy after menopause, because it was believed that long-term HRT protected women from heart disease. That's all changed.
In July 2002, a study by the U.S. National Heart, Lung, and Blood Institute, part of a huge research program called the Women's Health Initiative (WHI), suggested that HRT should not be recommended for long-term use; in fact, the results were so alarming, the study was halted before its completion date. It was found that Prempro, a combination of estrogen and progestin, which was a "standard issue" HRT formulation for postmenopausal women, increased the risk of invasive breast cancer, heart disease, stroke, and pulmonary embolisms (blood clots). The study participants were informed in a letter that they should stop taking their pills. However, Prempro did reduce the incidence of bone fractures from osteoporosis and colon cancer.
For women in good health without thyroid disease, taking HRT in the short term to relieve menopausal symptoms is still considered a good option, as there is no evidence to suggest that short-term use (one to five years) of HRT is harmful. The study has implications only for women on oral HRT for long-term use (versus the patch)—some-thing that was recommended to millions of women over the past twenty years because of perceived protection against heart disease.
In 1998, an earlier trial known as the Heart and Estrogen/Progestin Replacement Study (HERS) looked at whether HRT reduced risk in women who already had heart disease. HRT was not found to have any beneficial effect. Women who were at risk for breast cancer were never advised to go on HRT; similarly, women who had suffered a stroke or were considered at risk for blood clots were also never considered good candidates for HRT. It had long been known that breast cancer was a risk of long-term HRT, as well as stroke and blood clots. However, many women made the HRT decision based on the perceived heart disease protection. Today, the only thing the experts can agree on is that the HRT decision is highly individual and must be an informed decision, where all of the possible risks and benefits of taking—or not tak-ing—HRT are disclosed.
More recent analyses point to the fact that all problems with HRT identified to date stem from the use of oral HRT dosing. When estrogen pills are swallowed, they must be absorbed from the intestines into the blood that flows directly to the liver. This exposes the liver to much higher levels of estrogen than the rest of the body. Since the liver is the manufacturing site of clotting factors and cholesterol, oral HRT causes changes in the liver that are likely to be responsible for most of the HRT problems. The solution may be to use HRT patches. Putting the estrogen into the bloodstream by directly absorbing it through the skin avoids the liver problem and may prove to be safe and effective. This needs to be explored further in future clinical trials.
If you are suffering from great discomfort during perimenopause, and your thyroid hormone levels are normal (again, hypothyroid women in perimenopause may need to increase their thyroid hormone dosage), discuss with your health-care provider whether short-term HRT is an option. If you suffered from cardiovascular effects as a result of untreated hypothyroidism or thyrotoxicosis, oral HRT may be more risky for you, in light of the 2002 study results. So, ask about HRT patches.
Numerous natural methods are available to help control symptoms. For example, many women use soy, a plant estrogen (or phytoestrogen), in place of conventional HRT. It's critical to note that if you're on thyroid hormone, soy supplements taken within five hours of your thyroid hormone pill can decrease the absorption of thyroid hormone. Rather than increasing your dosages while on soy, it's better to pay attention to the timing of your pills. Sometimes taking your soy at night and your thyroid hormone pill in the morning may lessen the absorption problem, but it's important to monitor thyroid function with tests (see Chapter 2) while you're on soy.
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