HRT: Bioidentical vs Animal
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
HRT: A Tale Of Two Approaches
In yesterday’s newsletter, we asked you for your assessment of menopausal hormone replacement therapy (HRT).
- A little over a third said “It can be medically beneficial, but has some minor drawbacks”
- A little under a third said “It helps, but at the cost of increased cancer risk; not worth it”
- Almost as many said “It’s a wondrous cure-all that makes you happier, healthier, and smell nice too”
- Four said “It is a dangerous scam and a sham; “au naturel” is the way to go”
So what does the science say?
Which HRT?
One subscriber who voted for “It’s a wondrous cure-all that makes you healthier, happier, and smell nice too” wrote to add:
❝My answer is based on biodentical hormone replacement therapy. Your survey did not specify.❞
And that’s an important distinction! We did indeed mean bioidentical HRT, because, being completely honest here, this European writer had no idea that Premarin etc were still in such wide circulation in the US.
So to quickly clear up any confusion:
- Bioidentical hormones: these are (as the name suggests) identical on a molecular level to the kind produced by humans.
- Conjugated Equine Estrogens: such as Premarin, come from animals. Indeed, the name “Premarin” comes from “pregnant mare urine”, the substance used to make it.
There are also hormone analogs, such as medroxyprogesterone acetate, which is a progestin and not the same thing as progesterone. Hormone analogs such as the aforementioned MPA are again, a predominantly-American thing—though they did test it first in third-world countries, after testing it on animals and finding it gave them various kinds of cancer (breast, cervical, ovarian, uterine).
A quick jumping-off point if you’re interested in that:
Depot medroxyprogesterone acetate and the risk of breast and gynecologic cancer
this is about its use as a contraceptive (so, much lower doses needed), but it is the same thing sometimes given in the US as part of menopausal HRT. You will note that the date on that research is 1996; DMPA is not exactly cutting-edge and was first widely used in the 1950s.
Similarly, CEEs (like Premarin) have been used since the 1930s, while estradiol (bioidentical estrogen) has been in use since the 1970s.
In short: we recommend being wary of those older kinds and mostly won’t be talking about them here.
Bioidentical hormones are safer: True or False?
True! This is an open-and-shut case:
❝Physiological data and clinical outcomes demonstrate that bioidentical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more efficacious than their synthetic and animal-derived counterparts.
Until evidence is found to the contrary, bioidentical hormones remain the preferred method of HRT. ❞
Further research since that review has further backed up its findings.
Source: Are Bioidentical Hormones Safer or More Efficacious than Other Commonly Used Versions in HRT?
So simply, if you’re going on HRT (estrogen and/or progesterone), you might want to check it’s the bioidentical kind.
HRT can increase the risk of breast cancer: True or False?
Contingently True, but for most people, there is no significant increase in risk.
First: again, we’re talking bioidentical hormones, and in this case, estradiol. Older animal-derived attempts had much higher risks with much lesser efficaciousness.
There have been so many studies on this (alas, none that have been publicised enough to undo the bad PR in the wake of old-fashioned HRT from before the 70s), but here’s a systematic review that highlights some very important things:
❝Estradiol-only therapy carries no risk for breast cancer, while the breast cancer risk varies according to the type of progestogen.
Estradiol therapy combined with medroxyprogesterone, norethisterone and levonorgestrel related to an increased risk of breast cancer, estradiol therapy combined with dydrogesterone and progesterone carries no risk❞
In fewer words:
- Estradiol by itself: no increased risk of breast cancer
- Estradiol with MDPA or other progestogens that aren’t really progesterone: increased risk of breast cancer
- Estradiol with actual progesterone: back to no increased risk of breast cancer
So again, you might want to make sure you are getting actual bioidentical hormones, and not something else!
However! If you are aware that you already have an increased risk of breast cancer (e.g. family history, you’ve had it before, you know you have certain genes for it, etc), then you should certainly discuss that with your doctor, because your personal circumstances may be different:
❝Tailored HRT may be used without strong evidence of a deleterious effect after ovarian cancer, endometrial cancer, most other gynecological cancers, bowel cancer, melanoma, a family history of breast cancer, benign breast disease, in carriers of BRACA mutations, after breast cancer if adjuvant therapy is not being used, past thromboembolism, varicose veins, fibroids and past endometriosis.
Relative contraindications are existing cardiovascular and cerebrovascular disease and breast cancer being treated with adjuvant therapies❞
Source: HRT in difficult circumstances: are there any absolute contraindications?
HRT makes you happier, healthier, and smell nice too: True or False?
Contingently True, assuming you do want its effects, which generally means the restoration of much of the youthful vitality you enjoyed pre-menopause.
The “and smell nice too” was partly rhetorical, but also partly literal: our scent is largely informed by our hormones, and higher estrogen results in a sweeter scent; lower estrogen results in a more bitter scent. Not generally considered an important health matter, but it’s a thing, so hey.
More often, people take menopausal HRT for more energy, stronger bones (reduced osteoporosis risk), healthier heart (reduced CVD risk), improved sexual health, better mood, healthier skin and hair, and general avoidance of menopause symptoms:
Read more: Skin, hair and beyond: the impact of menopause
We’d need another whole main feature to discuss all the benefits properly; today we’re just mythbusting.
HRT does have some drawbacks: True or False?
True, and/but how serious they are (beyond the aforementioned consideration in the case of an already-increased risk of breast cancer) is a matter of opinion.
For example, it is common to get a reprise of monthly cramps and/or mood swings, depending on how one is taking the HRT and other factors (e.g. your own personal physiology and genetic predispositions). For most people, these will even out over time.
It’s also even common to get a reprise of (much slighter than before) monthly bleeding, unless you have for example had a hysterectomy (no uterus = no bleeding). Again, this will usually settle down in a matter of months.
If you experience anything more alarming than that, then indeed check with your doctor.
HRT is a dangerous scam and sham: True or False?
False, simply. As described above, for most people they’re quite safe. Again, talking bioidentical hormones.
The other kind are in the most neutral sense a sham (i.e. they are literally sham hormones), though they’re not without their merits and for many people they may be better than nothing.
As for being a scam, biodentical hormones are widely prescribed in the many countries that have universal healthcare and/or a single-payer healthcare system, where there would be no profit motive (and considerable cost) in doing so.
They’re prescribed because they are effective and thus reduce healthcare spending in other areas (such as treating osteoporosis or CVD after the fact) and improve Health Related Quality of Life, and by extension, health-adjusted life-years, which is one of the top-used metrics for such systems.
See for example:
Our apologies, gentlemen
We wanted to also talk about testosterone therapy for the andropause, but we’ve run out of room today (because of covering the important distinction of bioidentical vs old-fashioned HRT)!
To make it up to you, we’ll do a full main feature on it (it’s an interesting topic) in the near future, so watch this space
Ladies, we’ll also at some point cover the pros and cons of different means of administration, e.g. pills, transdermal gel, injections, patches, pessaries, etc—which often have big differences.
That’ll be in a while though, because we try to vary our topics, so we can’t talk about menopausal HRT all the time, fascinating and important a topic it is.
Meanwhile… take care, all!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Recommended
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
Using the”Task Zero” approach
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
“Jonathan Frakes Asks You Things” Voice:
- Do you ever find yourself in a room and wonder what you’re doing there?
- Or set about a to-do list, but get quickly distracted by side-quests?
- Finally get through to a person in a call center, they ask how they can help, and your mind goes blank?
- Go to the supermarket and come out with six things, none of which were the one you came for?
This is a “working memory” thing and you’re not alone. There’s a trick that can help keep you on track more often than not:
Don’t try to overburden your working memory. It is very limited (this goes for everyone to a greater or lesser degree). Instead, hold only two tasks at once:
- Task zero (what you are doing right now)
- Task one (your next task)
When you’ve completed task zero, task one becomes the new task zero, and you can populate a new task one from your to-do list.
This way, you will always know what you’re doing right now, and what you’re doing next, and your focus will be so intent on task zero, that you will not get sidetracked by task seventeen!
Happy focusing
Share This Post
-
In Plain English…
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
It’s Q&A Time!
This is the bit whereby each week, we respond to subscriber questions/requests/etc
Have something you’d like to ask us, or ask us to look into? Hit reply to any of our emails, or use the feedback widget at the bottom, and a Real Human™ will be glad to read it!
Q: Love to have someone research all the additives in our medicines, (risk of birth control and breast cancer) and what goes in all of our food and beverages. So much info out there, but there are so many variations, you never know who to believe.
That’s a great idea! There are a lot of medicines and food and beverages out there, so that’s quite a broad brief, but! We could well do a breakdown of very common additives, and demystify them, sorting them into good/bad/neutral, e.g:
- Ascorbic acid—Good! This is Vitamin C
- Acetic acid—Neutral! This is vinegar
- Acetylsalicylic acid—Good or Bad! This is aspirin (a painkiller and blood-thinning agent, can be good for you or can cause more problems than it solves, depending on your personal medical situation. If in doubt, check with your doctor)
- Acesulfame K—Generally Neutral! This is a sweetener that the body can’t metabolize, so it’s also not a source of potassium (despite containing potassium) and will generally do nothing. Unless you have an allergy to it, which is rare but is a thing.
- Sucralose—Neutral! This is technically a sugar (as is anything ending in -ose), but the body can’t metabolize it and processes it as a dietary fiber instead. We’d list it as good for that reason, but honestly, we doubt you’re eating enough sucralose to make a noticeable difference to your daily fiber intake.
- Sucrose—Bad! This is just plain sugar
Sometimes words that sound the same can ring alarm bells when they need not, for example there’s a big difference between:
- Potassium iodide (a good source of potassium and iodine)
- Potassium cyanide (the famous poison; 300mg will kill you; half that dose will probably kill you)
- Cyanocobalamine (Vitamin B12)
Let us know if there are particular additives (or particular medications) you’d like us to look at!
While for legal reasons we cannot give medical advice, talking about common contraindications (e.g., it’s generally advised to not take this with that, as one will stop the other from working, etc) is definitely something we could do.
For example! St. John’s Wort, very popular as a herbal mood-brightener, is on the list of contraindications for so many medications, including:
- Antidepressants
- Birth control pills
- Cyclosporine, which prevents the body from rejecting transplanted organs
- Some heart medications, including digoxin and ivabradine
- Some HIV drugs, including indinavir and nevirapine
- Some cancer medications, including irinotecan and imatinib
- Warfarin, an anticoagulant (blood thinner)
- Certain statins, including simvastatin
Q: As I am a retired nurse, I am always interested in new medical technology and new ways of diagnosing. I have recently heard of using the eyes to diagnose Alzheimer’s. When I did some research I didn’t find too much. I am thinking the information may be too new or I wasn’t on the right sites.
(this is in response to last week’s piece on lutein, eyes, and brain health)
We’d readily bet that the diagnostic criteria has to do with recording low levels of lutein in the eye (discernible by a visual examination of macular pigment optical density), and relying on the correlation between this and incidence of Alzheimer’s, but we’ve not seen it as a hard diagnostic tool as yet either—we’ll do some digging and let you know what we find! In the meantime, we note that the Journal of Alzheimer’s Disease (which may be of interest to you, if you’re not already subscribed) is onto this:
See also:
- Journal of Alzheimer’s Disease (mixture of free and paid content)
- Journal of Alzheimer’s Disease Reports (open access—all content is free)
Q: As to specific health topics, I would love to see someone address all these Instagram ads targeted to women that claim “You only need to ‘balance your hormones’ to lose weight, get ripped, etc.” What does this mean? Which hormones are they all talking about? They all seem to be selling a workout program and/or supplements or something similar, as they are ads, after all. Is there any science behind this stuff or is it mostly hot air, as I suspect?
Thank you for asking this, as your question prompted yesterday’s main feature, What Does “Balancing Your Hormones” Even Mean?
That’s a great suggestion also about addressing ads (and goes for health-related things in general, not just hormonal stuff) and examining their claims, what they mean, how they work (if they work!), and what’s “technically true but may
be misleading* cause confusion”*We don’t want companies to sue us, of course.
Only, we’re going to need your help for this one, subscribers!
See, here at 10almonds we practice what we preach. We limit screen time, we focus on our work when working, and simply put, we don’t see as many ads as our thousands of subscribers do. Also, ads tend to be targeted to the individual, and often vary from country to country, so chances are good that we’re not seeing the same ads that you’re seeing.
So, how about we pull together as a bit of a 10almonds community project?
- Step 1: add our email address to your contacts list, if you haven’t already
- Step 2: When you see an ad you’re curious about, select “share” (there is usually an option to share ads, but if not, feel free to screenshot or such)
- Step 3: Send the ad to us by email
We’ll do the rest! Whenever we have enough ads to review, we’ll do a special on the topic.
We will categorically not be able to do this without you, so please do join in—Many thanks in advance!
Share This Post
-
Passion Fruit vs Pomegranate – Which is Healthier?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Our Verdict
When comparing passion fruit to pomegranate, we picked the passion fruit.
Why?
Both of these fruits have beaten a lot of other contenders, so it’s time to pit them against each other:
In terms of macros, passion fruit has more protein, carbs, and fiber, the ratio of which meaning also that passion fruit has the lower glycemic index. So, we say passion fruit wins on macros.
In the category of vitamins, things are more even; passion fruit has more of vitamins A, B2, B3, B6, and C, while pomegranate has more of vitamins B1, B5, B9, E, and K. In light of this 5:5 tie, and since passion fruit’s overall vitamin coverage is better (in terms of meeting RDA needs) but pomegranate’s vitamins are often in shorter supply in diet, we’re calling it a tie on vitamins.
When it comes to minerals, passion fruit has more calcium, iron, magnesium, phosphorus, potassium, and selenium, while pomegranate has more copper, manganese, and zinc. That’s already an easy 6:3 win for passion fruit, before we even consider the fact that passion fruit’s minerals’ margin of difference is greater too.
Adding it up makes for a clear win for passion fruit. As ever when it comes to plants, enjoy both if you can, though!
Want to learn more?
You might like to read:
What’s Your Plant Diversity Score?
Take care!
Share This Post
Related Posts
-
The Mind-Gut Connection – by Dr. Emeran Mayer
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
We’ve reviewed books about the mind-gut connection before, so what makes this one stand out?
Firstly, it’s a lot more comprehensive than the usual “please, we’re begging you, eat some fiber”.
And yes, of course that’s part of it. Prebiotics, probiotics, reduce fried and processed foods, reduce sugar/alcohol, reduce meat, and again, eat some greenery.
But where this book really comes into its own is looking more thoroughly at the gut microbiota and their function. Dr. Mayer goes well beyond “there are good and bad bacteria” and looks at the relationship each of them have with the body’s many hormones, and especially neurotransmitters like serotonin and dopamine.
He also looks at the two-way connection between brain and gut. Yes, our gut gives us “gut feelings”, but 10% of communication between the brain and gut is in the other direction; he explores what that means for us, too.
Finally, he does give a lot of practical advice, not just dietary but also behavioral, to make the most of our mind-gut connection and make it work for our health, rather than against it.
Bottom line: this is the best book on the brain-gut connection that this reviewer has read so far, and certainly the most useful if you already know about gut-healthy nutrition, and are looking to take your understanding to the next level.
Click here to check out The Mind-Gut Connection, and start making yours work for your benefit!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
Astrology, Mental health and the Economics of Well Being
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Ultimately can the mental health system single-handedly address the concerns of inequality and economic access in society?
Around 75 per cent of the Indian population lives in rural areas, but their access to quality mental health care is limited and traditional approaches continue to be in use. The shortage is to such a large extent that there are only 0.7 physicians per 1000 population and only one psychiatrist for every 343,000 Indians. While over the years the mental health sector has seen major developments, like the 2017 mental health care act. This act establishes equal access for all citizens, to avail government-run or funded mental health services in the country. However, it does not bridge the gap in society as the majority of the population remains deeply unaware or unable to access these services.
While the uncertainties of the pandemic brought mental wellbeing to the forefront, the national budget for the sector dropped, making this an issue of human rights. This accessibility to services is further corroborated by the recurring financial expenses of medications and frequent visits to government clinics. The cost of sessions is steep and a single session is not ideal. Spending exorbitant amounts on healthcare is a burden most families can’t afford leading to debt. In the absence of insurance and healthcare schemes and provisions, therapy remains a luxury to many Indians.
Economic struggles are only one of the causes of this discerning gap in the mental health sector. Barriers caused by sexuality, gender, caste and religion also play a major role in mediating people’s perception and access to therapeutic services. The persistent stigma surrounding mental health, especially in India continues to be a hindrance to seeking help. The supernatural inhibitions and disparity in knowledge across communities only create more confusion. The notion that mental well being is an optional expense is popular, even though the country’s population is in a dire state. Data collected in a WHO report found that nearly 15 per cent of Indian adults need active intervention for one or more mental health issues.
The population disregards the very prevalence of such mental disorders and more than often finds it fruitless to receive treatment. Some who are open-minded fail to afford the hiked fees that therapists in urban settings charge, leaving them with no option. While for years Indians attributed the systemic weakness of the mental health system to the people’s attitudes, a 2016 survey showed more than 42% of people have positive attitudes toward mental wellbeing and treatment. While the skeptics remain, these underprivileged sections of society too struggle to gain the accessibility they deserve.
This is where astrology, tarot card reading and other spiritual practices, have created a market for themselves in the well-being industry. The sceptics, and those from poor socio-economic backgrounds resort to these local and easily accessible ways of coping, to instil the faith they so desperately need. Astrology is a layman’s substitute for therapy, or for some even a supplement when they cannot afford extended periods of treatment. Visiting a local astrologer in many ways breeds the self-awareness one would expect from a session in therapy. These practices even hold certain similarities to actual psychotherapy settings, in the way they define, and alleviate aspects of one’s personality and behaviour.
Very often one simply needs an explanation, or an answer to the ‘why’ no matter how scientifically rooted that response truly is. Astrologers impart a level of faith, that things will get better. For those in rural areas, struggling to provide the bare necessities to their family affording therapy is impossible, so their local psychic, astrologer or pandit becomes their anchor during emotional duress. Tarot cards and other practices primarily focus on the future and act as a guide point for how to deal with the things ahead. For a farmer coping with anxiety, access to anti-anxiety medication is strained, and so is therapy. His best bet remains to consult his next-door jyotish about his burdens.
A famous clinician Caroline Hexdall in an interview said that “ Part of the popularity of astrology and tarot today has to do with their universal nature”. With growing technology and the pervasiveness of social media, people can gain easy access to self-care and astrology resources. Apps and web pages provide daily tarot cards, zodiac signs readings and astrological predictions for people, and almost serve the purpose of a therapist. Is reading the lines on our palm, and checking the alignment of the stars enough to cure the mental illness they undergo? Is it a solution or a quick fix as a consequence of an ignorant healthcare system?
Several studies have also shown the deteriorating effects of depending on astrology. Cases of worsening and onset of depression, anxiety and personality disorders are common for those who use astrology as more than just a temporary coping mechanism. It also becomes a source of losing control, as every feeling is attributed to fate and destiny, instilling a sense of helplessness. Ultimately can the mental health system single-handedly address the concerns of inequality and economic access in society?
Maahira Jain is a third-year student at Ashoka University studying Psychology and Media studies. She is a movie buff and is extremely passionate about writing and traveling.
This article is republished from OpenAxis under a Creative Commons license. Read the original article.
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
Screaming at Screens?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
I Screen, You Screen, We All Screen For…?
Dr. Kathryn Birkenbach is a postdoctoral research fellow in the Department of Neuroscience at Columbia University, and Manager of Research at Early Medical in New York.
Kathryn has things to tell us about kids’ neurological development, and screen time spent with electronic devices including phones, tablets, computers, and TVs.
From the 1960s criticism of “the gogglebox” to the modern-day critiques of “iPad babies” as a watchword of parental neglect, there’s plenty people can say against screen time, but Dr. Birkenbach tells us the that the reality is more nuanced:
Context Is Key
On a positive note”: consistent exposure to age-appropriate educational material results in quicker language acquisition than media that’s purely for entertainment purposes, or not age-appropriate.
Contrary to popular belief, children do not in fact learn by osmosis!
Interaction Is Far More Valuable Than Inaction
Kathryn advises that while adults tend to quite easily grasp things from instructional videos, the same does not go for small children.
This means that a lot of educational programming can be beneficial to small children if and only if there is an adult with them to help translate the visual into the practical!
There’s a story that does the rounds on the Internet: a young boy wanted to train his puppy, but didn’t know how. He asked, and was told “search for puppy training on YouTube”. His parents came back later and found him with his iPad, earnestly showing the training videos to the puppy.
We can laugh at the child’s naïvety, knowing that’s not how it works and the puppy will not learn that way, so why make the same mistake in turn?
❝The phenomenon known as the “video deficit effect” can be overcome, when an on-screen guide interacts with the child or a parent is physically present and draws the child’s attention to relevant information.
In other words, interaction with others appears to enhance the perceived salience of on-screen information, unlocking a child’s ability to learn from a medium which would otherwise offer no real-world benefit.❞
Screens Can Supplement, But Can’t Replace, Live Learning & Play
Sci-fi may show us “education pods” in which children learn all they need to from their screen… but according to our most up-to-date science, Dr. Birkenbach says, that simply would not work at all.
Screen time without adult interactions will typically fail to provide small children any benefit.
There is one thing it’s good at, though… attracting and keeping attention.
Thus, even a mere background presence of a TV show in the room will tend to actively reduce the time a small child spends on other activities, including live learning and exploratory play.
The attention-grabbing abilities of TV shows don’t stop at children, though! Adult caregivers will also tend to engage in fewer interactions with their children… and the interactions will be shorter and of lower quality.
In Summary:
- Young children will tend not to learn from non-interactive screen time
- Interactive screen time, ideally with a caregiver, can be educational
- Interactive screen time, not with a carer, can be beneficial (but a weak substitute)
- Interactive screen time refers to shows such as Dora The Explorer, where Dora directly addresses the viewer and asks questions…But it’s reliant on the child caring to answer!
- It can also mean interactive educational apps, provided the child does consciously interact!
- Randomly pressing things is not conscious interaction! The key here is engaging with it intelligently and thoughtfully
- A screen will take a child’s time and attention away from non-screen things: that’s a genuine measurable loss to their development!
Absolute Bottom Line:
Screens can be of benefit to small children, if and only if the material is:
- Age-Appropriate
- Educational
- Interactive
If it’s missing one of those three, it’ll be of little to no benefit, and can even harm, as it reduces the time spent on more beneficial activities.
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
