I recently saw Margaret for a follow-up appointment after her first hormone pellet implants. Turns out she had seen her gynecologist for her annual exam in the interim. Her gynecologist voiced her strong disapproval of Margaret having undergone bio-identical hormone replacement therapy, especially considering that her mother had died of uterine cancer.
I explained to Margaret that she need not adopt her gynecologist’s concern for a number of reasons:
First, less than 5% of endometrial cancer is hereditary, so I’m at a loss to understand why Margaret is supposed to have more concern about this cancer than any other woman.
Second, had Margaret’s mother received hormone pellet implants and then developed uterine cancer, I could see why Margaret’s gynecologist might mistakenly assume that Margaret could be at higher risk. But Margaret’s mother had not received pellets or any other kind of hormone therapy. Consequently, Margaret’s family history again has no relevance to her own risk.
Third, her mother had spontaneous vaginal bleeding—a big red flag for endometrial cancer—for years after menopause and never brought it to medical attention until it was too late. Margaret has not had spontaneous vaginal bleeding, so her mother’s history is again irrelevant in her case.
Fourth, “hormones” don’t cause uterine cancer. Estrogen, when taken by itself over a period of years, can. This is why we always give progesterone with it, to protect the uterine lining from runaway growth stimulated by estrogen alone. However, this was yet another unfounded concern, since Margaret isn’t taking any estrogen, and is only making small amounts on her own.
Fifth, Margaret is taking progesterone for its many beneficial effects on sleep, brain function, heart health, bone health, immune function, and so much more. Any endometrial growth she might have from her small amount of estrogen will be neutralized by the progesterone she is taking.
Finally, in functional medicine, we don’t initiate a therapy and say goodbye for a year. We monitor. We ask questions. We want to know what is working, what is not working, what could stand to be better, and whether any undesired effects or complications are surfacing.
In other words, in spite of many years of education and training in the use of drugs and surgery, Margaret’s gynecologist lacks a basic understanding of how critical sex steroids are to healthy human function. She also lacks knowledge of why and how to replace these powerful molecules when our bodies no longer make them.
This is not surprising. Whenever gynecologists switch to functional medicine, they admit they didn’t learn anything substantive about hormones in medical school or residency. What little they did learn about hormone replacement was, unfortunately, incorrect. Why? Because they were taught to assume that drugs and hormones have the same effects.
For example, they were taught that hormones cause breast cancer, uterine cancer, blood clots, heart attacks, and strokes. This is akin to saying that food causes poisoning. It is true that some food causes poisoning, but only if it has toxins or disease-causing micro-organisms (such as bacteria or parasites) in it. That doesn’t mean that all food causes poisoning and must therefore be avoided at all cost.
In like manner, the common hormone substitution drugs Premarin and Provera do indeed increase risk of the diseases listed above. But these are not human hormones, so they have no business being substituted for the real deal. If you are lacking in hormones, I’m going to give you human hormones, not chemical substitutes. And I’m going to provide it through the route that is demonstrated, based on studies and experience, to be the most effective and safest: pellet implants.
Unfortunately, it is not rare for patients to face the disapproval of their well-meaning primary care doctors or gynecologists. Doctors only know what we are taught. If we don’t take the time to learn more about something on our own, we will continue to innocently mislead our patients. And today’s doctors will continue to pass on the same misunderstandings to tomorrow’s doctors.
Needless to say, I was grateful to Margaret for bringing to my attention her gynecologist’s concern. Patients naturally assume that, because gynecologists are trained in women’s health, they are experts in women’s hormones. If only this were true! Their pronouncements may sound authoritative, but dogmatic statements don’t trump scientific research and clinical results, which are the foundations of our work at Prestige Wellness Institute.
If you ever have a concern about your bio-identical hormone therapy, please do not hesitate to let us know. We always welcome the opportunity to shine more light on medical traditions that are not based on sound science and that hold patients back from achieving their optimal health and vitality.