A recent panel has re-evaluated the scientific literature
since the 2001 publication of the Women’s Health Initiative in order to
determine if hormone replacement therapy is safe long term and for chronic
conditions such as bone loss, cardiovascular risk, and / or mood health. The
results of this panel are from critical review of 51 published articles and
will guide the standard of care for postmenopausal women. Frankly, we’ve
learned a lot in the last 11 years and I think this panel did an excellent job
of culling the data albeit falling short of offering reasonable and safe
solutions to the challenge of increased risk of chronic disease beginning at
menopause. But that's okay. It wasn't their goal.
In full disclosure, I’m an
advocate of natural products so my first inclination is the cheer the panel’s
recommendation. It has been my read of the last decade of literature as well.
However, it is oversimplified to come to the conclusion that HRT is good or HRT
is bad. That binary way of thinking is ruinous. I strongly believe there is a
definite place for Hormone Replacement Therapy. I also believe it cannot be
used as the panacea it once was thought to be. In the case of bone health, we
must be ever mindful of the complete physiology. Sure, estrogen inhibits
osteoclastic activity and helps to maintain bone mineral density, but other
hormones have a role in osteoblastic activity such as progesterone and
testosterone. Growth hormone and cortisol have their own effects partially
independent of sex hormones and partially dependent on their levels. Furthermore,
we now have evidence that bone morphogenetic proteins, progenitor cells for
bone, have cross talk with estrogen and there may be other unknown interactions
to other hormones and signals. Some authorities now place osteopenia and
osteoporosis, especially precocious bone loss in the inflammatory disease
marker, causing us to work through the contribution of cytokines and
prostaglandins whose pathways are influenced by estrogen levels. And this is
just bone health, not to mention cardiovascular health and other quality of
life issues that are also influenced by hormone status. Why is this important
to say? Because, we haven’t heard the last of HRT. We will likely come to
understand a further undeclared subpopulation that has little to no risk of
cancer and cardiovascular incident. However, we aren’t there yet and we have
patients in front of us that need our help. This panel’s recommendation brings
us one step closer to the truth. What is missing from the conversation and
really outside the scope of this article is the reason for hormone imbalance
and potential less risky recommendations that clinicians can make today to
support not only the symptoms of menopause but also the long term consequences
of hormone loss. Personally, I’ve been involved in understanding this exact
mode of action. That is, improving the function of what has become known as the
HPA or hypothalamus-pituitary-adrenal axis. In fact, there are several axes
that we should be aware of that are influenced by an aging hypothalamus. These
axes, but particularly the HPA, when supported can stimulate the body’s own
production and balance of hormones. In essence, improving this system allows
the feedback and control of hormone production to be self-regulating without
the burden to liver biotransformation that exogenous hormones appear to have.
When a post-menopausal woman can improve her ability to produce her own
hormones with changes in menopausal symptoms, bone mineral density scores, and
cardiovascular support, then we have something to write about. This approach
can be used in conjunction with hormone therapy in order to be in line with the
recommendation of smallest dose, shortest duration of time. This is the
question that should be asked. “What can we do, today, for women to be on the
smallest dose of hormone replacement for the shortest amount of time and still
retain quality of life?” The question should not be “is HRT good?”. More
research into patient selection criteria is warranted. However, what I’m afraid
will happen, at the expense of quality patient care, is disregard for these
recommendation with some clinicians refusing to prescribe and others continuing
to over-prescribe. We want something with a broad therapeutic window with no
history of safety concerns. Something that supports endogenous hormone
production so that lowest dose, shortest duration can be honored. We want
something that has clinical trials that support efficacy in a broad spectrum of
conditions the way HRT does. What we want exists and is available on the market
as a natural product. Femmenessence (Maca-GO®) is that commercially available natural product. The following is a technical/ White Paper on the evidence of Femmenessence
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