Hormone Replacement Therapy When Is It Necessary?

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July 04, 2001 | 47,914 views

Part 1 of 5 (Part2, Part 3, Part4, Part 5)

TimO'Shea

Before researching the topic of estrogen,I admit my initial preconceptions about hormone replacementtherapy for menopause were less than brightness and trust.The usual pattern seems to be:

Guess I'm jaded. So sue me.

Trying to prove my preconceptions wrong, the research failedme. Anyone can see how the whole thing was set up. Now thischapter is not light reading, even though I tried. But ifyou are a woman, you need to read the whole thing. Afterthat, you're on your own.

Drug Hoax Phenomena AreNot New

The same thing happened in the Boer War (Hadwen), in thePhilippines in 1905 (Hume, p 200), and in Desert Storm.Mass administration of drugs that killed many more peoplethan they saved. The difference here is that today the controlof information has become much more sophisticated, the focusbeing trust your doctor, trust your doctor - you reallydon't have to understand the details.

The target is the 30 million menopausal American women,and the game is the $1 billion HRT industry, a verticallyintegrated boom market.

Here's The Basic Story

Since the 1930s, American women have been trained and bulliedinto thinking that a natural normal event in their life- menopause - is a disease condition requiring treatment.Let's stop with that for a minute.

If it's a disease, how did all the millions of women throughouthistory up to the present time muddle through it? How doThird World women or non-HMO lifestyles survive the ordeal?Keep those two questions in mind when you read anythingmainstream, either advertising or articles.

The "new" "medical condition" requiresdrug therapy, which coincidentally has just recently been"discovered": synthetic estrogen - hormone replacementtherapy. Does it work? Are women better off now? Does itreally prevent osteoporosis? Read on!

What Is Menopause?

Menopause is a period of years in a normal woman's lifein which gradual hormonal changes bring about a shift awayfrom the physical powers of childbearing, in favor of amore mature condition of mental development and wisdom.

The unpleasant symptoms we have come to associate with menopauseare common only in a small group of women in history: Americanand Northern European women in the past 75 years. Outsidethat group, menopause is not so problematic and is takenmore in stride as a natural phase in a woman's life, withlittle fanfare. It seems that the more simple the lifestyle,and the more simple the diet - the more effortless the transition.

Throughout history, simple diet has been a function of lowincome. The most nutritious foods are the least expensive:whole fruits and vegetables, unprocessed dairy, whole grains.As lifestyle became more complex, and incomes grew, expensive,empty, processed, nutrient-deficient foods were popularizedby marketing and advertising - the foods of commerce. (RoyalLee)

Less need to exercise, more focus on money, greater stress- the basic formula for the rise of the most resistant groupof diseases in history : the degenerative diseases. Heartdisease, cancer, arthritis, diabetes, osteoporosis - areepidemic in our society, the richest nation in history.Even 100 years ago such diseases were rare.

By now most of us have heard of a Shangri-La place in theHimalayas called Hunza Land, famous for longevity to 120years old. Two Americans, Dr. Allen Banik and Renee Taylor,visited this isolated mountain civilization, one in 1958and one in 1962.

Both wrote books describing their incredible experiences.Both detail the simple diet as well as the lack of degenerativediseases, and infectious diseases as well. Physically cutoff from the world by treacherous mountain passes, the Hunzasdeveloped their own agriculture system of stone terraces,fed by the mineral rich waters of the glaciers. Hunza healthis probably unequalled anywhere in the world, or in history.Symptoms of menopause were unheard of in Hunza Land.

In Japan as well as in many other cultures with basic, unrefineddiets, there is no word for "hot flashes." Aswe shall see, the unpleasant symptoms of menopause are directlyrelated to the amount of estrogen a woman has maintainedduring her adult life, prior to menopause.

Natural phytoestrogens (plant-estrogens) are found in plantslike licorice, soybeans, alfalfa, and many others, in verysmall amounts. Phytoestrogens are weak estrogens and blockthe stronger forms. A diet abundant in phytoestrogens beforemenopause will do much to moderate the day-to-day estrogenlevel so that when menopause arrives, there will not besuch big drop.

The Creation Of A Market:

How Didthe Whole HRT Thing Get Started In The First Place?

The story really begins in 1938 with the discovery of diethylstilbestrol(DES) by Charles Dobbs. DES was supposed to be the first"synthetic estrogen" - an oxymoron, as we shallsee. Dobbs first thought DES would solve the problems ofmenopause, but the AMA immediately began to make extravagantpredictions for "preventing miscarriages" andsolving all problems of pregnancy as well. (Robbins, p138)

After many years, DES was being prescribed for a "safepregnancy" and to "prevent miscarriages."By 1960 it was found that between 60 and 90% of DES daughtershad abnormal sex organs, leading to high rates of infertility,miscarriages, and cervical cancer. (Sellman p28). DES sonscommonly had testicular dysfunctional and were often sterile.

As for the mothers who had taken DES, their risk of breastcancer had been increased by 40%. (Meyers p 143) DES wasthe first drug ever invented that could cause cancer inthe offspring when taken by the mother. (Reusch, p 22) Butstill the drug wasn't taken off the market until 1971! (Kamen, p99). By that time the industry didn't need DES anymore for its bottom line, because ERT was off and running.

Next Contestant

Public attention was then diverted away from the disastersof DES by a 1966 best seller called Feminine Forever, byRobert Wilson, a New York gynecologist. Wilson's thesiswas that menopause is an estrogen-deficiency disease. Allthe unpleasant symptoms which accompany menopause were thesimple result of too little estrogen. Insufficient estrogensupposedly caused a woman to lose her youth, beauty, cheerfulattitude, and bone density all at once, with the onset ofmenopause.

Not missing a beat, the drug industry immediately donated$1.3 million to set up the Wilson Foundation for the solepurpose of developing and promoting estrogen drugs. Theusual story: limited studies with inconclusive results,skewing results to please the company that was paying forthe trials, discontinuing studies that weren't turning out"right" ...

The primary study that was the basis for vaulting syntheticestrogen into the limelight, originally as a contraceptive,was a small, flawed trial done in Puerto Rico, in which20% of the 132 women suffered serious side effects. Fiveof them died.

Negatives were swept under the carpet as irrelevant - themain thing was that the new wonder drug supposedly cancelledthe "horrible" symptoms of menopause - hot flashes,vaginal dryness, migraines, etc. FDA approval for syntheticestrogen was given based on this one study! (Marshall) Throughout1964 and 1965, fueled by the advertising power of the biggestclients, articles appeared in major women's magazines, likeVogue, Cosmopolitan, and Good Housekeeping proclaiming abreakthrough that would finally set women free from theravages of the dread menopause. (Lee p24)

Within a few years, with no real proof that Wilson was right,with superficial clinical trials, synthetic estrogen wasbeing popularly prescribed, and a new industry was off andrunning. They called it Estrogen Replacement Therapy. Betterliving through chemistry.

A Little Snag Came UpIn 1975

The New England Journal of Medicine (Dec 1975 p.1199) publishedits findings after studying the causes of endometrial cancer.They showed that women who took the new estrogen drugs hadjust increased their risk of endometrial cancer by a factorof five times. Unless they had been using the drugs longerthan seven years. Then it was 14 times the normal incidence.

Sales slowed

Yankee ingenuity to the rescue: it was found, though notconclusively, that rates of endometrial cancer could bereduced if synthetic progesterone were added to the syntheticestrogen. Synthetic progesterones are called progestins.So they changed the name from Estrogen Replacement Therapyto Hormone Replacement Therapy, and the show went on. Salesclimbed back up, and then continued to grow. And grow.

With similar results to the 1975 study, 20 years later theAmerican Cancer Society conducted a huge 13-year study ofsome 240,000 postmenopausal women to find the relation betweenHRT and cancer. Their findings: 40% higher incidence ofovarian cancer; after 11 years of HRT, the figure went to70%! (Rodriguez)

How Could This Be?

As the HRT industry gained strength, the manufacturers beganto make additional claims about the benefits of HRT, claimsthat were again unsupported by solid research:

The underlying, and unproven, assumptionof this new "therapy" - HRT - was that women'slives were being improved now that they were spared thehorrors of aging, menopause, osteoporosis, and the lossof femininity. Unfortunately, these promises are rarelykept, and almost never because of a program of synthetichormones.

Worse, the side effects of HRT have proven to be a biggerproblem than what they were supposed to cure.

To begin to untangle this giant web of doubletalk and wronginformation, we have to look at some basic endocrinology:Can't tell the hormones without a program. If this getstoo complicated for the attention-challenged, just skipto the next section, but at least give it a try.

Hormones

They are chemical compounds that are players in the mostsophisticated and exquisitely balanced internet in the entirebody: the endocrine system. This group of glands, includingthe adrenals, the pituitary, the ovaries, the testes, thethyroid, and the hypothalamus are interrelated in impossiblycomplex ways, about which we're just beginning to get glimpsesof understanding.

It's a swirling universe of chemical elegance and precision,involving millions of refined little molecular firings whichwink in and out of existence every second. "Touch onestrand and the whole web trembles," is the way endocrinologistDeepak Chopra puts it. The endocrine system controls allother systems of the body by means of chemical messengers,who wait for an answer.

WhatIs Estrogen?

Estrogen is a hormone, one of the moving parts of thatendocrine system. It is a steroid (made from cholesterol)hormone, occurring in both men and women.

Estrogen's functions are primarily the growth and developmentof sex organs and other tissues related to reproduction(Guyton p1023)

For a basic overview of one little part of the endocrinesystem, John Lee has a very clear summary, like a recipe,for one group of hormones, those made from cholesterol,the steroid hormones:

cholesterol > >
>> pregnenolone  
v
v
 
v
v
 
v
progesterone > > corticosterone and aldosterone
v
v
 
v
v
 

17 OH pregnenolone

>

17 OH progesterone > >

cortisol
v
v
 
v
v
 
DHEA
<>
androstenedione> estrone estriol
v
v
 
^
^
 
androstenedio
<>
testosterone > >
estradiol
v
 
estriol
 
   

 
   
Lee, p14
 


Don't worry, there's no quiz. Dr. Lee just wanted to showa little corner of the complex give-and-take between hormones,how a change in any one hormone in this chart can affectmany others. Lee and Chopra both speak of the dance ofthe hormones, the delicately interwoven choreography,about which we have only the most rudimentary knowledge.

We've begun fooling around with this highly tuned endocrinesystem because we've discovered a few coarse, synthetic,sledgehammer substances that resemble real estrogen, orreal thyroid hormone, or real progesterone. But we reallyhave only the vaguest notion what we're doing, becauseof all the overlapping interrelationships. Our ignorancehas given rise to a brand new disease: endometrial cancer.Plus other big problems.

Back To Estrogen

Estrogen is really a general term for three separate hormones:

From here on out in this chapter,"estrogen" as is produced by the body refersto all three of the above hormones.

Estrogen is produced in three main places in a woman'sbody:

The main purpose of estrogen is tomake the uterine lining, the endometrium, ready to implanta fertilized egg in the event fertilization occurs. Toaid in this function, estrogen will promote

All the above is OK if pregnancy islikely. But excess estrogen throws off the timing. Excessestrogen causes the body to prepare for embryo implantationall the time. This state of over-preparation is the causeof

Every system in the body has a feedbackloop to keep balance. Estrogen has a sister hormone calledprogesterone, whose functions are equally important.

Part2