HRT: Bioidentical vs Animal

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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

Source: Estradiol therapy and breast cancer risk in perimenopausal and postmenopausal women: a systematic review and meta-analysis

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:

Menopausal Hormone Replacement Therapy and Reduction of All-Cause Mortality and Cardiovascular Disease

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

  • Vaping: A Lot Of Hot Air?
  • What are the most common symptoms of menopause? And which can hormone therapy treat?
    Menopause myths debunked: hormone therapy’s real benefits and the quest for symptom relief.

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  • 8 Signs Of Iodine Deficiency You Might Not Expect

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    Health Coach Kait (BSc Nutrition & Exercise) is a certified health and nutrition coach, and today she’s here to talk about iodine—which is important for many of our body functions, from thyroid hormone production to metabolic regulation to heart rate management, as well as more superficial-but-important-too things like our skin and hair.

    Kait’s hitlist

    Here’s what she recommends we look out for:

    • Swollen neck: even a slightly swollen neck might indicate low iodine levels (this is because that’s where the thyroid glands are)
    • Hair loss: iodine is needed for healthy hair growth, so a deficiency can lead to hair loss / thinning hair
    • Dry and flaky skin: with iodine’s role in our homeostatic system not being covered, our skin can dry out as a result
    • Feeling cold all the time: because of iodine’s temperature-regulating activities
    • Slow heart rate: A metabolic slump due to iodine deficiency can slow down the heart rate, leading to fatigue and weakness (and worse, if it persists)
    • Brain fog: trouble focusing can be a symptom of the same metabolic slump
    • Fatigue: this is again more or less the same thing, but she said eight signs, so we’re giving you the eight!
    • Irregular period (if you normally have such, of course): because iodine affects reproductive hormones too, an imbalance can disrupt menstrual cycles.

    For more on each of these, as well as how to get more iodine in your diet, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Further reading

    You might also like to read:

    Take care!

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  • Cleaning Up Your Mental Mess – by Dr. Caroline Leaf

    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.

    First of all, what mental mess is this? Well, that depends on you, but common items include:

    • Anxiety
    • Depression
    • Stress
    • Trauma

    Dr. Caroline Leaf also includes the more nebulous item “toxic thoughts”, but this is mostly a catch-all term.

    Given that it says “5 simple scientifically proven steps”, it would be fair if you are wondering:

    “Is this going to be just basic CBT stuff?”

    And… First, let’s not knock basic CBT stuff. It’s not a panacea, but it’s a great tool for a lot of things. However… Also, no, this book is not about just basic CBT stuff.

    In fact, this book’s methods are presented in such a novel way that this reviewer was taken aback by how unlike it was to anything she’d read before.

    And, it’s not that the components themselves are new—it’s just that they’re put together differently, in a much more organized comprehensive and systematic way, so that a lot less stuff falls through the cracks (a common problem with standalone psychological tools and techniques).

    Bottom line: if you buy one mental health self-help book this year, we recommend that it be this one

    Click here to check out Cleaning Up Your Mental Mess, and take a load off your mind!

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  • Kiwi vs Grapefruit – 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 kiwi to grapefruit, we picked the kiwi.

    Why?

    In terms of macros, kiwi has nearly 2x the protein, slightly more carbs, and 2x the fiber; both fruits are low glycemic index foods, however.

    When it comes to vitamins, kiwi has more of vitamins B3, B6, B7, B9, C, E, K, and choline, while grapefruit has more of vitamins A, B1, B2, and B5. An easy win for kiwi.

    In the category of minerals, kiwi is higher in calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while grapefruit is not higher in any minerals. So, no surprises for guessing which wins this category.

    One thing that grapefruit is a rich source of: furanocoumarin, which can inhibit cytochrome P-450 3A4 isoenzyme and P-glycoptrotein transporters in the intestine and liver—slowing down their drug metabolism capabilities, thus effectively increasing the bioavailability of many drugs manifold.

    This may sound superficially like a good thing (improving bioavailability of things we want), but in practice it means that in the case of many drugs, if you take them with (or near in time to) grapefruit or grapefruit juice, then congratulations, you just took an overdose. This happens with a lot of meds for blood pressure, cholesterol (including statins), calcium channel-blockers, anti-depressants, benzo-family drugs, beta-blockers, and more. Oh, and Viagra, too. Which latter might sound funny, but remember, Viagra’s mechanism of action is blood pressure modulation, and that is not something you want to mess around with unduly. So, do check with your pharmacist to know if you’re on any meds that would be affected by grapefruit or grapefruit juice!

    All in all, adding up the categories makes for an overwhelming total win for kiwis.

    Want to learn more?

    You might like to read:

    Top 8 Fruits That Prevent & Kill Cancer ← kiwi is top of the list!

    Take care!

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Related Posts

  • Vaping: A Lot Of Hot Air?
  • Undo The Sun’s Damage To Your Skin

    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 often said that our skin is our largest organ. Our brain or liver are the largest solid organs by mass (which one comes out on top will vary from person to person), our gut is the longest, and our lungs are the largest by surface area. But our skin is large, noticeable, and has a big impact on the rest of our health.

    The sun is one of the main damaging factors for our skin; assorted toxins are also a major threat for many people, and once the skin barrier gets broken, it’s a field-day for bacteria.

    So, what can we do about it?

    Tretinoin: the skin’s rejuvenator

    Tretinoin is also called retinoic acid, not to be mistaken for retinol, although they are both retinoids. Tretinoin is much stronger.

    As for what it’s stronger at:

    It’s usually prescribed for the treatment of sun-damage, acne, and wrinkles. Paradoxically, it works by inflaming the skin (and then making it better, and having done so, keeping it better).

    In few words: it encourages your skin to speed up its life cycle, which means that cells die and are replaced sooner, which means the average age of skin cells will be considerably younger at any given time.

    This is the same principle as we see at work when it comes to cellular apoptosis and autophagy in general, and specifically the same idea as we discussed when talking about senolytics, compounds that kill aging cells:

    Fisetin: The Anti-Aging Assassin

    About that paradoxical inflammation…

    ❝The topical use of tretinoin as an antiacne agent began almost a half century ago. Since that time it has been successfully used to treat comedonal and inflammatory acne.

    Over the intervening years, the beneficial effects of tretinoin have grown from an understanding of its potent cornedolytie-related properties to an evolving appreciation of its antiinflammatory actions.

    The topical use of clindamycin and tretinoin as a combination treatment modality that includes antibacterial, comedolytic, and antiinflammatoiy properties has proven to be a very effective therapy for treating the various stages of acne

    It is now becoming increasingly clear that there may be good reasons for these observations.❞

    ~ Drs. Schmidt & Gans, lightly edited here for brevity

    Read in full: Tretinoin: A Review of Its Anti-inflammatory Properties in the Treatment of Acne

    Against damage by the sun

    The older we get, the more likely sun damage is a problem than acne. And in the case of tretinoin,

    ❝In several well-controlled clinical trials, the proportion of patients showing improvement was significantly higher with 0.01 or 0.05% tretinoin cream than with placebo for criteria such as global assessment, fine and coarse wrinkling, pigmentation and roughness.

    Improvements in the overall severity of photodamage were also significantly greater with tretinoin than with placebo.

    Several placebo-controlled clinical studies have demonstrated that topical tretinoin has significant efficacy in the treatment of photodamaged skin. Improvements in subjective global assessment scores were recorded in:

    49–100% of patients using once-daily 0.01% tretinoin,

    68–100% of patients using 0.05% tretinoin, and

    0–44% of patients using placebo.❞

    ~ Drs. Wagstaff & Noble

    …which is quite compelling.

    Read in full: Tretinoin: A Review of its Pharmacological Properties and Clinical Efficacy in the Topical Treatment of Photodamaged Skin

    This is very well-established by now; here’s an old paper from when the mechanism of action was unknown (here in the current day, 17 mechanisms of action have been identified; beyond the scope of this article as we only have so much room, but it’s nice to see science building on science):

    ❝Tretinoin cream has been used extensively to reverse the changes of photoaging. It is the first topical therapy to undergo controlled clinical testing and proved to be efficacious. These results have been substantiated with photography, histopathologie examination, and skin surface replicas.

    Tretinoin cream has an excellent safety record; a local cutaneous hypervitaminosis A reaction is the only common problem.❞

    ~ Dr. Goldfarb et al.

    Read in full: Topical tretinoin therapy: Its use in photoaged skin

    Is it safe?

    For most people, when used as directed*, yes. However, it’s likely to irritate your skin at first, and that’s normal. If this persists more than a few weeks, or seems unduly severe, then you might want to stop and talk to your doctor again.

    *See also: Scarring following inappropriate use of 0.05% tretinoin gel

    (in the case of a young woman who used it 4x daily instead of 1x daily)

    Want to try some?

    Tretinoin is prescription-only, so speak with your doctor/pharmacist about that. Alternatively, retinal (not retinol) is the strongest natural alternative that works on the same principles; here’s an example product on Amazon 😎

    Take care!

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  • What is PMDD?

    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.

    Premenstrual dysphoric disorder (PMDD) is a mood disorder that causes significant mental health changes and physical symptoms leading up to each menstrual period.

    Unlike premenstrual syndrome (PMS), which affects approximately three out of four menstruating people, only 3 percent to 8 percent of menstruating people have PMDD. However, some researchers believe the condition is underdiagnosed, as it was only recently recognized as a medical diagnosis by the World Health Organization.

    Read on to learn more about its symptoms, the difference between PMS and PMDD, treatment options, and more.

    What are the symptoms of PMDD?

    People with PMDD typically experience both mood changes and physical symptoms during each menstrual cycle’s luteal phase—the time between ovulation and menstruation. These symptoms typically last seven to 14 days and resolve when menstruation begins.

    Mood symptoms may include:

    • Irritability
    • Anxiety and panic attacks
    • Extreme or sudden mood shifts
    • Difficulty concentrating
    • Depression and suicidal ideation

    Physical symptoms may include:

    • Fatigue
    • Insomnia
    • Headaches
    • Changes in appetite
    • Body aches
    • Bloating
    • Abdominal cramps
    • Breast swelling or tenderness

    What is the difference between PMS and PMDD?

    Both PMS and PMDD cause emotional and physical symptoms before menstruation. Unlike PMS, PMDD causes extreme mood changes that disrupt daily life and may lead to conflict with friends, family, partners, and coworkers. Additionally, symptoms may last longer than PMS symptoms.

    In severe cases, PMDD may lead to depression or suicide. More than 70 percent of people with the condition have actively thought about suicide, and 34 percent have attempted it.

    What is the history of PMDD?

    PMDD wasn’t added to the Diagnostic and Statistical Manual of Mental Disorders until 2013. In 2019, the World Health Organization officially recognized it as a medical diagnosis.

    References to PMDD in medical literature date back to the 1960s, but defining it as a mental health and medical condition initially faced pushback from women’s rights groups. These groups were concerned that recognizing the condition could perpetuate stereotypes about women’s mental health and capabilities before and during menstruation.

    Today, many women-led organizations are supportive of PMDD being an official diagnosis, as this has helped those living with the condition access care.

    What causes PMDD?

    Researchers don’t know exactly what causes PMDD. Many speculate that people with the condition have an abnormal response to fluctuations in hormones and serotonin—a brain chemical impacting mood— that occur throughout the menstrual cycle. Symptoms fully resolve after menopause.

    People who have a family history of premenstrual symptoms and mood disorders or have a personal history of traumatic life events may be at higher risk of PMDD.

    How is PMDD diagnosed?

    Health care providers of many types, including mental health providers, can diagnose PMDD. Providers typically ask patients about their premenstrual symptoms and the amount of stress those symptoms are causing. Some providers may ask patients to track their periods and symptoms for one month or longer to determine whether those symptoms are linked to their menstrual cycle.

    Some patients may struggle to receive a PMDD diagnosis, as some providers may lack knowledge about the condition. If your provider is unfamiliar with the condition and unwilling to explore treatment options, find a provider who can offer adequate support. The International Association for Premenstrual Disorders offers a directory of providers who treat the condition.

    How is PMDD treated?

    There is no cure for PMDD, but health care providers can prescribe medication to help manage symptoms. Some medication options include:

    • Selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants that regulate serotonin in the brain and may improve mood when taken daily or during the luteal phase of each menstrual cycle.
    • Hormonal birth control to prevent ovulation-related hormonal changes. 
    • Over-the-counter pain medication like Tylenol, which can ease headaches, breast tenderness, abdominal cramping, and other physical symptoms.

    Providers may also encourage patients to make lifestyle changes to improve symptoms. Those lifestyle changes may include:

    • Limiting caffeine intake
    • Eating meals regularly to balance blood sugar
    • Exercising regularly
    • Practicing stress management using breathing exercises and meditation
    • Having regular therapy sessions and attending peer support groups

    For more information, talk to your health care provider.

    If you or anyone you know is considering suicide or self-harm or is anxious, depressed, upset, or needs to talk, call the Suicide & Crisis Lifeline at 988 or text the Crisis Text Line at 741-741. For international resources, here is a good place to begin.

    This article first appeared on Public Good News and is republished here under a Creative Commons license.

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  • The Dark Side Of Memory (And How To Make Your Life Better)

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    How To Stop Revisiting Those Memories

    We’ve talked before about putting the brakes on negative thought spirals (and that’s a really useful technique, so if you weren’t with us yet for that one, we do recommend hopping back and reading it!).

    We’ve also talked about optimizing memory, to include making moments unforgettable.

    But what about the moments we’d rather forget?

    First, a quick note: we have no pressing wish or need to re-traumatize any readers, so if you’ve a pressing reason to think your memories you’d rather forget are beyond the scope of a few hundred words “one quick trick” in a newsletter, feel free to skip this section today.

    One more quick note: it is generally not considered healthy to repress important memories. Some things are best worked through consciously in therapy with a competent professional.

    Today’s technique is more for things in the category of “do you really need to keep remembering that one time you did something embarrassing 20 years ago?”

    That said… sometimes, even when it does come to the management of serious PTSD, therapy can (intentionally, reasonably) throw in the towel on processing all of something big, and instead seek to simply look at minimizing its effect on ongoing life. Again, that’s best undertaken with a well-trained professional, however.

    For more trivial annoyances, meanwhile…

    Two Steps To Forgetting

    The first step:

    You may remember that memories are tied to the senses, and the more senses are involved, the more easily and fully we remember a thing. To remember something, therefore, we make sure to pay full attention to all the sensory experience of the memory, bringing in all 5 senses if possible.

    To forget, the reverse is true. Drain the memory of color, make it black and white, fuzzier, blurrier, smaller, further away, sterile, silent, gone.

    You can make a habit of doing this automatically whenever your unwanted memory resurfaces.

    The second missing step:

    This is the second step, but it’s going to be a missing step. Memories, like paths in a forest, are easier to access the more often we access them. A memory we visit every day will have a well-worn path, easy to follow. A memory we haven’t visited for decades will have an overgrown, sometimes nearly impossible-to-find path.

    To labor the metaphor a little: if your memory has literal steps leading to it, we’re going to remove one of the steps now, to make it very difficult to access accidentally. Don’t worry, you can always put the step back later if you want to.

    Let’s say you want to forget something that happened once upon a time in a certain workplace. Rather than wait for the memory in question to come up, we’re going to apply the first step that we just learned, to the entire workplace.

    So, in this example, you’d make the memory of that workplace drained of color, made black and white, fuzzier, blurrier, smaller, further away, sterile, silent, gone.

    Then, you’d make a habit of doing that whenever that workplace nearly comes to mind.

    The result? You’re unlikely to accidentally access a memory that occurred in that workplace, if even mentally wandering to the workplace itself causes it to shrivel up and disappear like paper in fire.

    Important reminder

    The above psychological technique is to psychological trauma what painkillers are to physical pain. It can ease the symptom, while masking the cause. If it’s something serious, we recommend enlisting the help of a professional, rather than “self-medicating” in this fashion.

    If it’s just a small annoying thing, though, sometimes it’s easier to just be able to refrain from prodding and poking it daily, forget about it, and enjoy life.

    Don’t Forget…

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