There is a lot of hype in the media about the danger of Hormone Replacement Therapy (HRT) for women. On one hand we hear about the possible increased risk of breast cancer and heart disease. On the other hand, celebrities like Suzanne Summers tout the benefits of HRT. The information can be very confusing — so what are we to think?

Let’s sort through some of the confusion, define some terminology, and make the issues a little clearer. In addition, I will add my own views of how and when to use HRT.

Part of the confusion relating to hormone replacement comes from the term “HRT”. There are two types of HRT and both involve replacing missing or low levels of hormones. The difference is, the first type uses synthetic, man-made hormones; the second uses bio-identical hormones.

Unfortunately, both types of therapy often get lumped together and talked about by the mainstream media as if they are the same. Nothing could be further from the truth.

Synthetic hormones are made in a lab and the chemical structures that make them up are not identical to the hormone they are trying to replace. For example Premarin is a hormone made by a drug company to replace naturally occurring estrogen in post-menopausal females.

Premarin actually stands for Pregnant Mares Urine, which is the source of the estrogen-like compound. But it happens to work on the same receptor site in the body because one part of the molecule looks like estrogen to the receptor. Unfortunately, no one really knows what the rest of the molecule may do in the body.

Natural or bio-identical hormones on the other hand are usually made at a compounding pharmacy. They are derived from plant sources and the final product is exactly the same molecule that the body would produce. This gives the advantage of producing the same result you would expect with the natural hormone — without any untoward side effect. But because there have been no head to head studies comparing bio-identical hormones to synthetic ones, the results of most HRT trials get lumped together as if they were the same thing.

In my practice, I prescribe bio-identical hormones for the women in whom I consider HRT warranted. These include estrogen, progesterone, and testosterone. In some cases I will recommend pregnenolone and melatonin, hormones that can be purchased over the counter. Each of these hormones has benefits that can improve symptoms of menopause as well as increase health and longevity.

It is truly miraculous to see the transformation in women with severe hot flashes, depressed mood, decreased energy, low sex drive and other symptoms of menopause as we get their hormone levels balanced and they get their life back in only 6 to 8 weeks after starting therapy.

Finally, it is very important to have your thyroid function tested. Do not settle for the classic medical test of only doing a TSH (Thyroid Stimulating Hormone). Your physician should also test T-4 and Free T-3 to ensure your levels are not only in the normal range but in the optimal normal range. This is particularly true if you are having symptoms of fatigue, being cold all the time, dry skin, or hair loss.

Before deciding on bio-identical hormone replacement therapy, discuss your risk factors and family history with a knowledgeable physician. It is also important to find a reputable compounding pharmacy to fill your prescription.

In addition to HRT, follow these other guidelines to stay at a decreased risk for disease. Some of these factors may be much more important to your long term health.

1. Keep on eye on your blood pressure and make sure it is within normal limits.
2. Make sure your lipid panel is normal.
3. Have your blood glucose (sugar) checked regularly to catch early diabetes.
4. Lose weight and in particular, decrease your abdominal fat.
5. Have a bone density test done. This will identify your risk for osteoporosis.
6. Have regular mammograms and do self exams.
7. Have a pap smear annually for at least 3 years and then if normal, talk with your doctor about how often to have them done after that.

Much more research still needs to be done in this field and the recommendations may still change, so stay tuned.

[Ed. Note: Tim Reynolds, M.D., is a practicing physician and a health and lifestyle expert. For more information, click here.]