To Your Health

Q. I am nearing menopause and really worried about osteoporosis now that we know hormone replacements carry an increased risk of cancer and heart disease. What are the alternatives?

A. You do not need to give up hormone replacement therapy. There are other hormones besides estrogen that do not increase the risk of cancer and heart disease. The best of these is the "natural" hormone progesterone, which is available as a nonprescription cream. Don't confuse progesterone with the synthetic hormone medroxyprogesterone acetate or progestin, which is the usual hormone in prescription hormone replacement therapy (HRT) under the brand name Provera™. It is progestin, not natural progesterone, that is now coming under fire.

For decades both estrogen and progestin were widely prescribed to reduce the discomfort of hot flashes near menopause. A few years ago the makers of progestin and the most popular estrogen, Premarin™, began to promulgate the theory that these hormones also reduced the incidence of cancer and heart disease. Women were encouraged to use HRT for many years, not just the few years close to menopause, to reduce the discomfort of hot flashes. The first evidence that HRT was not reducing, but actually increasing, the risk of cancer, heart disease, and osteoporosis was published about three years ago, and since then the evidence has increased and is now irrefutable.

The good news is that all the benefits promised by HRT are actually realized for virtually all women when natural progesterone is used regularly. Natural progesterone cream has been available for 20 years, but without the profits derived from a patent, its popularity has largely been fueled by word of mouth. Clinical studies that would document claims of benefits are costly and are just now being performed, but the experience of most women is that progesterone cream delivers on its promises with very few side effects.

Pregnancy is the time when a woman's body produces the highest amounts of progesterone. Progesterone cream used at the recommended amount, 20mg twice a day for about three weeks of the month, supplies only about 1/10 this amount, though it is still enough that the common discomforts of pregnancy, sore breasts, and fatigue are occasionally noted. If discomfort is noted, a reduction in the amount used often takes care of the problems while benefits continue. A 2-ounce tube should ordinarily last about a month.

A word of caution about wild yam cream. Although it is used in the manufacturing laboratory as the starting material to synthesize progesterone, it is not converted to progesterone in the body and will not have the same effects as progesterone. Wild yam cream does have substances with estrogen activity, called phytoestrogens, which have effects different from progesterone. You should be sure you need estrogens before using wild yam cream.

Don't forget that proper exercise and a diet rich in whole foods contributes amply to long-term health. Cutting back on caffeine and alcohol also improves your chances of dodging cancer, heart disease, and osteoporosis. Adding a good multivitamin/mineral and extra amounts of certain antioxidants such as vitamin C and vitamin E are worthwhile moves.

Research over the years has revealed several vital roles for progesterone regarding the function of heart, blood vessels, nerves, and brain. Natural progesterone in small amounts often makes life after menopause much happier for women.