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Suzanne Somers has taken menopause by storm. Her new book, The Sexy Years, has mobs of over-50 menopausal women finding hope in the message of sexy aging. Ms. Somers has made “bio-identical hormones” hot on the lips of every woman and man coming to grips with the aging process. While this is a welcome spotlight on a subject that is of benefit and importance and is finally reaching a wide audience – there is a major issue in the book that has made women apprehensive and some scared enough to avoid HRT altogether.

Ms. Somers claims that cycling (creating a period every month) is recommended and natural. She reasons that because women menstruate when they are young it is advantageous to continue to menstruate forever. Cycling occurs when hormone levels drop. If a woman stops taking progesterone for a few days every month she will cycle and bleed and this will simulate the natural process. The problem is – menopausal women do not need to menstruate and taking hormones does not necessitate cycling. The primary reason women menstruate is to clean the uterus in preparation for the eventual implantation of a fertilized egg. If one is not interested in becoming pregnant, there is no physiologic reason to menstruate.

Another reason not to cycle is the loss of protection that takes place when progesterone is not present. It is well documented that bio-identical progesterone protects the breast and uterus against cancer. The bleeding that takes place with menstruation is not what protects the uterus against cancer – it is the direct effect of progesterone on the uterus that protects it. Stopping progesterone for a week means the body is without protective benefits for those days. It makes no sense to lose these important protective benefits even for a few days every month.

In fact, a recent article in the Obstetric/Gynecological literature claimed that unexpected vaginal bleed was the most common reason women stopped taking HRT. The cessation of periods was one thing women welcomed with menopause. Further, medical literature often addresses how to stop and prevent post-menopausal vaginal bleeding so that women will be more comfortable with continuing HRT. With increased progesterone levels to prevent bleeding and appropriate balancing of estrogen and progesterone, women should not bleed and will be more satisfied with continuous use of HRT.

For years, women have been treated with birth control pills taken continuously and not cycled to control PMS. It is the fall in hormones that takes place right before a period that causes symptoms of PMS. By taking birth control pills continuously, a woman can avoid this drop in hormones and the symptoms of PMS. Newer birth control pills are now cycled for bleeding every four months – we now realize that even pre-menopausal women do not need to menstruate as often – let alone post-menopausal women.

There are more faulty assumptions about HRT – not the least of which is that Hormone Replacement Therapy puts one in a state of pregnancy as Somers suggest. During pregnancy estrogen levels are in the thousands, while on estrogen replacement , ideal estradiol levels are typically 50/100 ml/dl. Ms. Somers' desire to link youthful, fertile states with the aging process is understandable – few (if any) relish the idea of losing “potency”, yet HRT is not intended to turn back the clock in that sense. Hormone replacement is a method of retaining the benefits of hormones on an entire system from mental acuity to better muscle retention – but it is not a means of falsely inducing or tricking the body into believing it is once again in its reproductive years.

The real benefits of Bio-Identical or Natural HRT is the protection it affords. Recent studies have shown that Provera (medroxy progesterone) increases the risk of breast cancer and increases the thickening of the breast tissue. It does this by direct stimulation (up regulation) of estrogen receptor sites in the breast. One study showed that Provera increased breast stimulation by 400% over baseline. The same study showed that bio identical progesterone – different from Provera – does not stimulate breast tissue as it down regulates receptor sites in the breast. Once again – why lose this protective effect of progesterone by stopping it for a few days every month?

With regard to protection for the uterus, there is a condition known as "endometrial hyperplasia" which causes increased thickening of the endometrial stripe or uterine lining and is the precursor to cancer. This condition must be treated to avoid the development of cancer. And the treatment is high doses progesterone to shrink this tissue. If repeat ultrasound does not show a decrease in endometrial lining, then the progesterone dose is doubled. The shrinkage of the endometrial tissue is a result of direct stimulation by the hormones. The protection does not occur because of the shedding of the lining. The more hormone, the better the protection against cancer.

In summary, women on hormone replacement therapy do not need to cycle (stop progesterone) and bleed on a periodic basis. There is no substantial benefit to the body to bleed regularly. The protective benefits and convenient regimen certainly makes bio identical hormone replacement therapy more attractive for women.

This information is provided courtesy of
Neal Rouzier, M.D.