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Hormone Replacement Therapy - An effective adjunct treatment for Fibromyalgia?

Posted Feb 16 2012 9:01pm

Fibromyalgia Syndrome occurs most often in women who are perimenopausal or postmenopausal. This suggests that decreasing female reproductive hormone levels may be involved in the development of fibromaylgia. Hormone replacement therapy or HRT involves the supplementation of the female hormones estrogen and progesterone for the relief of menopausal symptoms including hot flashes and vaginal dryness. There are few studies on the effectiveness of HRT taken by persons with fibromyalgia however many women including myself have experienced an improvement in symptoms when taking female hormones.

Both Chronic Fatigue and Fibromyalgia Syndromes are stress response related disorders that produce abnormalities and disruptions in the endocrine system and specifically to what is referred to as the Hypothalamus-Pituitary-Adrenal (HPA) axis. This results in decreased cortisol production and adrenal exhaustion. For more on this read my post "Adrenal Exhaustion" http://fibrofriends.typepad.com/fibro_friends/2008/10/adrenal-fatigue.html  . I suspect that these abnormalities also result in a deficiency of estrogen that is a major contributor to many symptoms associated with fibromyalgia

One reason why hormone replacement therapy may help with fibromyalgia symptoms is that magnesium utilization is increased by the presence of estrogen. Magnesium is critical for hundreds of enzymatic reactions in the human body. Adequate amounts of it are necessary for proper ATP synthesis and muscle functioning and a deficiency of magnesium can result in muscle soreness and tension, poor sleep, tension and migraine headaches, anxiety, hyperactivity, and constipation - all symptoms common to fibromyalgia syndrome. Scientific studies also support that estrogens are good for skeletal muscle function and strength and that female hormonal decrease is associated with a greater incidence of muscle injury and a delay in recovering from these injuries. 

There are a variety of female hormonal supplements and methods of applications including pill form, patch, cream and vaginal preparations. Estrogen is usually prescribed along with progesterone unless a woman no longer has a uterus because supplementing with estrogen alone can increase the risk of uterine cancer. Sources of estrogen include conjugated equine estrogens obtained from pregnant mares' urine, synthetic estradiol, or plant based estradiol obtained from soy or yams. Sources for progesterone include some type of synthetic progesterone or progestin, or micronized progestrone from plant sources. Standard HRT contains various combinations of these hormones.

Bioidentical hormone replacement therapy (BHRT) is a term referring to the use of un-patentable plant derived hormones that have the same molecular structure as the hormones in the human body. Supplements often contains the three forms of estrogen that naturally occur in the body - estriol, estrone and estradiol plus micronized or "natural" progesterone. They are typically prescribed by naturopathic and "alternative" physicians who use saliva tests to measure hormone levels and then customize formulas for individual patients that are prepared by a compounding pharmacy. Hormones are often prepared in transdermal creams applied to the skin and labia that go directly into the bloodstream bypassing the liver. BHRT is considered by some to be a safer alternative to standard HRT however there have been no clinical trials comparing the effectiveness or relative safety of bioidentical versus nonbioidentical compounds. 

In 2002 the use of HRT declined after a study initiated by The Women's Health Initiative was discontinued because researchers found that women taking HRT in the form of Premarin (conjugated equine strogen plus progestin) had a greater incidence of coronary heart disease, breast cancer, stroke, and pulmonary embolism along with a decreased risk of colorectol cancer and fewer fractures. The study which began in 1991 was part of a 15-year project sponsored by the National Institutes of Health on health issues for older women. Later data suggested that the risk of menopause hormones was considerably less for younger women and that certain women who used only estrogen had a reduced risk for breast cancer and heart attacks. As a result of the study long term use of HRT is no longer recommended for post menopausal women and HRT is typically only prescribed for short term relief of menopausal symptoms at low doses. 

During the ten years leading up to menopause when I had chronic fatigue I suffered from severe night sweats. Several alternative health practitioners prescribed "natural" or bioidentical progesterone for me but this only intensified my symptoms. At the onset of menopause my health deteriorated dramatically and I started having fibromyalgia like symptoms in my muscles. Working with a naturopathic physician and results from a saliva female hormone test I tried Biodentical Hormone Replacement Therapies but this failed to relieve my menopausal symptoms and increased my night sweats. I was recommended a form of HRT by my nurse practitioner called Activella, which is a combination of 1 mg. plant based estrodial and .5 mg. progestin. I tolerated this formula quite well with no adverse effects and my hot flashes and vaginal dryness went away within a week. 

When I began taking Activella my health condition was at an all time low. I was happy to not have to deal with menopausal symptoms on top of everything else and I did not notice any improvement in any other symptoms. Several years later I began to make breakthroughs in my health with therapies that I have discussed in this blog, specifically Oral Systemic Balance, Wilson's Syndrome protocol, and LENS neurofeedback. After eight years of taking Activella I thought that it might be a good idea to decrease my HRT since I was well past the menopausal period for which HRT is currently recommended. My naturopathic physician was concerned by the results of a saliva hormonal test that showed very elevated levels of estradial. At the recommendation of my nurse practitioner I started to skip taking Activella one day a week. During that time I had flares in my fibromyalgia around once a week but I did not suspect this had anything to do with skipping one day of my HRT. Then I decreased my dose in half, taking a half tablet of Activella each day. I did not experience a return of hot flashes which I interpreted as a good sign however after a week I experienced a flare in my fibromyalgia that lasted not just for a few days but continued for two weeks and was the worst setback in muscle pain and disturbed sleep with heat at night in many years. After two disabling weeks I suspected that the decrease in HRT might have something to do with my relapse. I went back on my regular dose of Activella and a week later my intense symptoms went away. 

The experience of decreasing the amount of HRT I take made me realize how important female hormones are to my health situation. As an experiment I tried increasing the Activella by one-half each day to see if this could provide any further benefits but I experienced symptoms of taking too much estrogen - sore breasts. I also experimented with taking additional progesterone both synthetic progestin which was not helpful and bioidentical progesterone which once again produced heat at night. Curious about the efficacy of various laboratory tests I did blood tests for estradiol and progesterone which were low when I was on the half dose of Activella. I also did a 24 hour urine hormone profile considered by some to be the gold standard of hormone testing which measured extremely high levels of estrogens, which is normal for persons taking oral estrogen. The laboratory also measured other forms of estrogens, which according to the laboratory physician as well as two of my personal physicians did not have markers indicating a potential risk for cancer. 

I have come to the conclusion for myself that taking HRT in the form of Activella is very helpful for my health. Since my "experiment" I have stayed regular with my dose and my fibromyalgia symptoms are better. Unfortunately because of the current reluctance in the medical community to prescribe HRT because of risk factors found in the Women's Health Initiative, many women with chronic fatigue and fibromyalgia may be discouraged to try a therapy that may benefit their condition. I personally think that the testing of hormones using saliva, blood or urine should not be the determining factor in deciding the correct dose of hormones, rather HRT should be adjusted to the symptoms of the patient. In regards to large studies, it is important to remember that all postmenopausal women like all people are medically not the same. Individual women will respond differently to various forms of HRT and need to find out for themselves which type is beneficial for their health. I have many friends who continue to take HRT well into their 60's and 70's and would not consider stopping because of how it contributes to their quality of life. I suspect that for many women with fibromyalgia and chronic fatigue syndrome this is also true. 

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