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Christiane Northrup, MD

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Hormone Therapy: Synthetic Progestins Are Not The Same As Progesterone

Posted: 11/24/09 08:39 AM ET

It's 2002 all over again, and women are being warned against taking hormone replacement because of its link to breast cancer. Why is history repeating itself? Because we haven't learned an important lesson. Synthetic progestins are not the same as progesterone, and reporting on them as if they confer the same risks and benefits is absurd.

I'm talking about the study in the New England Journal of Medicine dated February 5, 2009, which concludes that hormone therapy doubles the risk of breast cancer. Specifically, women past menopause who take both estrogen and progestin (such as in the form of Prempro) for five years or more have twice the risk of developing breast cancer. When these same women stopped their combination hormone formula, the number of breast cancer incidents dropped by about 28 percent within the first year.

This study is a follow-up to the landmark Women's Health Initiative that studied more than 15,000 women between the ages of 50 and 79 who were taking HRT. In 2002, the study was stopped when researchers concluded that Prempro caused higher incidents of heart problems and breast cancer. Interestingly, the number of breast cancer cases dropped significantly since 2003.

Dr. Rowan Chlebowski, a medical oncologist at Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, wanted to know why. So he assembled a team of researchers to determine if it was due to women halting their HRT or to more vigilant mammography practices.

It's related to HRT use; getting regular mammograms didn't affect the numbers at all. But it's not related to all hormone therapy! The women who took only estrogen (usually in the form of Premarin) without the progestin were no more likely to develop breast cancer than women who took no hormones at all. (Progesterone lowers the risk of uterine cancer. Women without a uterus aren't typically given a progestin.) This means the synthetic progestin is the likely culprit.

Flashback to 2002. Women around the world stopped HRT cold turkey, causing many to feel unhealthy. Why? Because many healthcare providers and researchers didn't know or appreciate the difference between a synthetic progestin and progesterone, which is a bioidentical hormone.

Progesterone matches a woman's body exactly and has been shown to ease mood, sleep, and cycle-related issues. Progesterone supplementation has another unique advantage--it can be converted to other hormones, such as testosterone and DHEA, if needed.

Synthetic progestin is an altogether different substance known to actually exacerbate perimenopausal and post-menopausal symptoms--in addition to increasing your risk of breast cancer, heart disease, and stroke.

It's hard to believe that seven years have passed and yet the difference between synthetic progestins and progesterone is not widely understood. I've recommended progesterone instead of progestin for more than 20 years. It matches a woman's body better than a synthetic hormone ever could. And, as the study shows, doesn't increase the risk of breast cancer.

I encourage every woman to learn about the hormone therapy options available today. They are vast, and there are many excellent choices made from bioidentical hormones. I also encourage every woman to look with a critical eye when reading the news about HRT. It's likely that there will continue to be controversial and conflicting information.

For a primer on bioidentical hormones, read "The ABC's of HRT" in the Women's Wisdom Circle.

For more cutting edge articles on health and wellness, visit Drnorthrup.com and sign up for the Women's Wisdom Circle.

Copyright Christiane Northrup, Inc. All rights reserved. Reproduction in whole or in part without permission is prohibited.

This information is not intended to treat, diagnose, cure, or prevent any disease.
All material in this article is provided for educational purposes only. Always seek the advice of your physician or other qualified health care provider with any questions you have regarding a medical condition, and before undertaking any diet, exercise, or other health program.

Reference:

Chlebowski, Rowan T., 2009. Breast cancer after use of estrogen plus progestin in postmenopausal women, New England Journal of Medicine, February 5, Volume 360:573-587.

 

Follow Christiane Northrup, MD on Twitter: www.twitter.com/drchrisnorthrup

It's 2002 all over again, and women are being warned against taking hormone replacement because of its link to breast cancer. Why is history repeating itself? Because we haven't learned an important l...
It's 2002 all over again, and women are being warned against taking hormone replacement because of its link to breast cancer. Why is history repeating itself? Because we haven't learned an important l...
 
 
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06:17 AM on 12/10/2009
Synthetic progestins are definitely not same as progesterone. Everybody knows it but, I appreciate you buys for discussing lot of things regarding this issue.
08:06 AM on 12/09/2009
Yes, synthetic progestins are not same as progesterone. I completely agree with you. Anyway thanks for sharing the article it is very informative.
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jacquelinenh
HuffPo Addict
10:33 PM on 11/29/2009
Women to Women has some good articles about the pros and cons of HRT and bioidenticals. I trust their advice (and it doesn't hurt that Dr. Northrup cofounded the place). Their take on New findings on HRT since the Women’s Health Initiative: http://www.womentowomen.com/bioidentical-hrt/womenshealthinitiative-newfindings.aspx
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Nelson Montana
Artist, Author, Composer
01:40 PM on 11/28/2009
I think there's some confusion regarding bio identical, synthetic and what not. A molecule is recognized by the body by what it is. It's like a key to a lock. It doesn't matter if it's the original or a duplicate. An estrogen molecule is an estrogen molecule just as vitamin C made in a laboratory is recognized in the same way as vitamin C in an orange. (Though there are other factors as well -- Im speaking strictly of the one thing that is being duplicated).

But most synthetic thyroid medications only contain T4 and THAT is the problem, not the source. The Armour contains a natural balance of all the thyroid hormones, but it's the HORMONES, not the NATURALNESS of it that makes it superior. And "herbal alternatives" aren't in high enough dosages to sufficiently replace a deficiency.
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Artemis34
"Women 4 the GOP" is like "Chickens 4 the KFC"
12:42 AM on 11/25/2009
This is supposed to be a list of doctors who write prescriptions for human bio-identical hormone replacement

http://biomimetic-hormones.com/bioidentical-doctors/
12:12 AM on 11/25/2009
Hit perimenopause much earlier than expected - thanks to a jerk off religious OBGYN who decided that since I hadn't procreated by 34, he'd snip off an ovary rather than remove just the cyst because it was faster and easier (and I still got pregnant twice after that so pfffffft).

BHR's are a GODSEND! I use the Vivelle Dot patch and prometrium and you will have to pry them from my cold, dead hands. I feel 25 again. No more mood swings, hot flashes, sweating and I'm chasing my poor husband all over the house again. He has even said he doesn't care what it costs, he'll pay it! Sadly my insurance will only pay for the cheap, synthetic drugs but I figure since I don't drink coffee, it's about as much as a daily 'fix' if I was a Starbucks junkie. ;)
01:12 AM on 11/25/2009
now this is good to hear! thanks!
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HUFFPOST COMMUNITY MODERATOR
ConfuciusSay-
Aglets: their purpose is sinister.
07:33 AM on 11/25/2009
1) Since you got pregnant afterward, he caused you no reproductive harm, and since you were never pregnant before, the removal of the diseased ovary seems to have helped.

2) Removal of one ovary does not cause premature menopause, if the other one is healthy. Since you got pregnant afterward, it seems to have been so.

Why do people hate their doctors?
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mlaiuppa
Pres. Sarcasm Society. Like we need your approval.
12:01 AM on 11/25/2009
It isn't that easy if your doctor is insistent and won't budge.

I want to take natural thryoid instead of synthetic Synthroid. My doctor refuses to prescribe it. That means I have to go outside my insurance and find a doctor that will prescribe it, then I have to buy it from a pharmacy outside my insurance plan and pay full price whatever it is.

I'm not menopausal yet, but if it's the synthetic progestin or nothing, then I go without.

I am sick of being held hostage by the medical community and insurance companies.
12:56 AM on 11/25/2009
But if you weren't paying for insurance you could afford to get the care you need. I do not have insurance (at age 60) and feel quite lucky to be able to use the cash saved to purchase thyroid I need (non synthetic).

But watch out. Mandatory health insurance and a national formulary will mean Synthroid for all because it is from a drug company. The times they are a changing. I don't know what I will do if I have to pay for insurance. I certainly will not begin to see a doctor, but I don't know how much of my current protocol I will be able to afford. I am so much healthier since I opted out of medical care. I actually use half the thyroid I did last year because I am also on iodine....wow! it changed my life. It was even better than dessicated thyroid. I dropped 15 lbs immediately and feel great. How many doctors know about iodine? Maybe 5 in all the U.S.

It's unethical to force people to participate in sub optimal health care. I can't believe we are looking at forced health care. I am very sad at what Obama has done to us. And shocked so many people follow dumbed down medicine like sheep. Take charge of your body! Be proactive, it's your life.
02:01 AM on 11/25/2009
ask your doctor to prescribe levoxyl, a plant-derived hormone replacement for low thyroids.

my insurance covers it and it is very inexpensive at any rate.
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Nelson Montana
Artist, Author, Composer
09:53 AM on 11/25/2009
If I'm not mistaken, Levoxl is a different brand name for sythroid -- the synthetic version of T4. Many drugs are derived from "natural" sources.
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Artemis34
"Women 4 the GOP" is like "Chickens 4 the KFC"
11:53 PM on 11/24/2009
If someone has a bad heart, and we give them a heart transplant, isn't that a natural replacement therapy?

If hormone levels have failed, like the failing heart, natural replacement therapy should be an option.
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HUFFPOST COMMUNITY MODERATOR
ConfuciusSay-
Aglets: their purpose is sinister.
07:36 AM on 11/25/2009
+1

Well said.
Unfortunately, companies that patent *new* versions of the progestins can then sell them for profits. There's less profit in the old formulations.

Until the studies emerge.
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HUFFPOST BLOGGER
Nelson Montana
Artist, Author, Composer
11:44 PM on 11/24/2009
Part of the negative side effects of hormones at an older age is the very fact that cells don't replicate as effectively in an older person. (Yep, everything about aging stinks). It's silly to say "let's wait to see how this pans out" when the people taking it are in their 40's, 50's and 60's. if they die 20 years later is the result of the hormones?!

Another thing post menopausal women should look into is a little testosterone, which also drops to next to nothing after age 50, yet women need a little (Just as men need a little estrogen -- the yin and yang).

This is still new to may doctors, especially old ones . Don't get the gel for women though. Since it cost the same as the higher dose male version it would be far more effective to get that version and simply use less. (Not having health insurance teaches you tricks like this).
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03:02 AM on 11/28/2009
All this medical advice! Your credentials?
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Nelson Montana
Artist, Author, Composer
06:11 AM on 11/28/2009
No medical degree but I am pretty good at diagnosing when someone has a stick up their ass.
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Artemis34
"Women 4 the GOP" is like "Chickens 4 the KFC"
11:25 PM on 11/24/2009
It isn't even logical that natural, bio-identical hormone increase risk of cancer. If that were true, then these cancers would be highest in teens and young adults when these hormones are highest.

Obviously it is the synthetic that creates greater risk.

And they say there are studies to prove [that substances that occur naturally in our bodies] are safe. I say there aren't studies to prove fingers are safe on my hand either. I won't cut them off because of that!
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yankhadenuf
Let them eat trickled down crumbs
10:28 PM on 11/24/2009
I never got any hormone therapy after my hysterectomy in 2006. After my surgery, my surgeon, who is also an oncologist, never even brought the topic up at follow-up appointments.
His silence spoke volumes.
07:03 PM on 12/01/2009
Really? How did you interpret his silence? What was your age at surgery?
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yankhadenuf
Let them eat trickled down crumbs
09:02 AM on 12/08/2009
NoSillyName "Really? How did you interpret his silence? What was your age at surgery?"
I was 48. I interpreted his silence that hormone therapy is unnecessary, and harmful as well.
09:03 PM on 11/24/2009
Progesterone is easily and cheaply rendered from a common yam. As a naturally occurring substance requiring no special processes to distill, it can't be patented and thereby controlled and exploited. Progestins are concocted in laboratories and are patented, thereby making them lucrative to their creators. Is it any surprise the industry conflates the two at every turn?
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Nelson Montana
Artist, Author, Composer
09:27 PM on 11/24/2009
But even in a highly concentrated supplemental form, it is not absorbed orally very well and would have little effect if you were deficient.
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Artemis34
"Women 4 the GOP" is like "Chickens 4 the KFC"
11:30 PM on 11/24/2009
Right.

You can buy natural progesterone creams over the counter as well as get an Rx to have them compounded.

http://www.emerita.com/index.cfm/category/27/monthly_promotions.cfm

I recommend going to or calling your local compounding pharmacy and asking them who writes Rx's for human bio-identical hormone creams and go straight to them. That way you skip all the non-believers.
09:01 AM on 11/25/2009
As someone who has been taking progesterone for five years, I can assure you that it's extremely effective in alleviating the symptoms of menopause. In fact, progesterone is found to be effective in daily doses as small as 10 - 12 mg, roughly the amount the body would normally produce.
05:44 PM on 11/24/2009
This reminds me of those tests done in a Scandinavian country (sorry, it was over a decade ago and I didn't take notes) trumpeting that beta-carotene doesn't help prevent cancer. The test was done using SYNTHETIC beta-carotene, and the subjects of the study were all smokers.

Using a synthetic to test efficacy of a natural substance is kind of like taste-testing a plastic cheese sandwich... there may be significant similarities, but it is NOT the same thing.
04:38 AM on 11/25/2009
weatherwax - that is so true.
Unfortunately the HRT business is worth billions - so there's always 'a little something' just right for you.
Read up, educate yourselves, ask questions. Why have women become conditioned into accepting HRT wholesale.
Remeber - the menopause has been 'medicalised' - just like infertility - with a dependence on synthetic hormone cocktails that alleviate the symptoms by various degrees of control.
Check out alternative approaches.
I am through the other end - and I refused point blank to be someone's guinea pig, or be herded along with a patch here or some 'maybe better' number there.
it isn't something new for women - we've been at this for ever!
Excercise, meditate, eat sensibly stay in contact with your body yourself - don't let the big fat greedy pharma industry make you feel you have to have such and such hormones.
You see - we don't really know the true long term effects.
05:14 PM on 11/24/2009
Estradiol patches are relatively inexpensive and are bioidentical estrogen. You don't need compounded creams. Use a patch with some ProGest progesterone from Whole Foods.

As for no studies having been done on bioidenticals:
http://biomimetic-hormones.com/page/2/
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arneader
04:50 PM on 11/24/2009
A woman does not stand a chance.... I just finished taking BIO IDENTICALS that did not work... (it may have be the pharmacist--and he not knowing what he was doing).. Now I'm only the hormone patch and I feel ONE HUNDRED times better! I feel like a breath of fresh air.
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PoliticalJunkie65
"Buzzinga!"
07:01 PM on 11/24/2009
Please tell me...what patch? (for gawd's sake!) :-) and :-( all at the same time!!!!!
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LaurieAnn
Charity is NOT a substitute for justice.
11:13 PM on 11/24/2009
Maybe the Climara bioidentical estradiol? That's what I'm taking.