26 Mar Transdermal Estradiol Preserves Brain Volume in Women
Hormone replacement therapy for women has undergone a Renaissance in recent years following the decades long fear of HRT caused by the Women’s Health Initiative. A recent study that supports the use of transdermal estradiol is remarkable for two reasons.
First of all, it is a pharmaceutical based research publication which would either typically not be published if the findings suggest a non-patented drug to be superior or which might have methodological flaws showing a biased result for a patented drug. Secondly, it focuses on two biomarkers of brain aging that support the widely held belief that estradiol is a neurotrophic factor crucial in the preservation of cognitive function and prevention of dementia later in life.
In this study, 75 women participating in the Kronos Early Estrogen Prevention Study (KEEPS) at the Mayo Clinic were assessed with cognitive testing and an MRI scan of the brain at baseline, 18 months, 3 years, 4 years and seven years during the KEEPS trial. A subset of 68 of the 75 women also had beta-amyloid Pittsburgh compound B-positron emission tomography (PET) scanning to detect brain plaques known to proceed memory loss and Alzheimer’s Disease by decades in most patients.
The most important finding is the observation that dorsolateral prefrontal cortex volumes were preserved in the transdermal estradiol group compared with placebo, but not in the oral hormonal therapy group.
The oral hormonal therapy was conjugated equine estrogens which was shown in the women’s health initiative to also increase the risk of breast cancer and cardiovascular events.
The amazing fact is a comment by the principal investigator Kantarci who said “ That was something that surprised us, one would think that estrogens whether they are given through one route or another would have similar effects. So there may be a hidden benefit with the transdermal treatment.” The problem is that the conventional medicine and pharmaceutical industries continue to ignore the fact that synthetic estrogens, particularly administered orally, are harmful whereas bioidentical estrogens administered transdermally or transmucosally are not. This study is further evidence that bioidentical estradiol given transdermally (and transmucosally) is superior in benefit and inferior in harm compared to oral conjugated estrogens (Premarin) derived from pregnant mare urine, a patented pharmaceutical.
The greater volume preservation in the trans group dermal estradiol group detected by MRI scanning was also associated with Lowell lower Global cortical beta-amyloid deposition on pet scans. This suggests bioidentical estradiol therapy could have long-lasting effects on the brain. Currently Health Canada on the FDA approves the use of a variety of estrogen and progesterone medications for reducing the symptoms of menopause during early menopause. A recent position paper published by the American Association of Clinical Endocrinologists and the American College of endocrinology published in July of 2017 very clearly supports the use of transdermal estrogen and oral micronized progesterone compared to synthetic pharmaceuticals:
- RECOMMENDATION: the use of transdermal as compared with oral estrogen preparations may be considered less likely to produce thrombotic risk and perhaps the risk of stroke and coronary artery disease.
- RECOMMENDATION: when the use of progesterone is necessary, micronized progesterone is considered the safer alternative
Take Home Points:
- The use of menopausal hormone therapy in symptomatic postmenopausal women should be based on consideration of all risk factors for cardiovascular disease, age, and time from menopause
- The use of transdermal/transmucosal as compared with oral estrogen preparations may be considered less likely to produce thrombotic risk and perhaps the risk of stroke and coronary artery disease
- When the use of progesterone is necessary, micronized progesterone is considered the safer alternative
Dr. Randy Knipping BSc MD CCFP FAARFM
Lifestyle Medicine & Integrative Health