Menopausal Myths

by Sherrill Sellman

The Berlin Wall of Hormone Replacement Therapy came tumbling down on July 17 with the formal announcement in the Journal of the American Medical Association that the $600 million study called the Women’s Health Initiative would be stopped three years earlier than planned. The study presented irrefutable evidence of the harm that estrogen-progestin therapy was doing to women. It was official—Hormone Replacement Therapy (HRT) increased the risk of developing breast cancer, strokes and heart disease. What had, in fact, been known for decades now became public knowledge. The use of synthetic HRT was a major medical mistake. Doctors are now questioning their most preferred treatment for menopause. Both menopausal women and their doctors are in a true quandary about what to do now. It appears that there is even more confusion about HRT and menopausal symptoms than ever. Therefore, unravelling the many myths, misinformation and, in some cases, lies about menopause is vital, ensuring women safe passage through their menopausal years.

Historical Myths
The 1960s heralded a new era for the menopausal woman. No longer was the prevailing Victorian view of menopause, as a mysterious debilitating psychological condition, the vogue. Instead of treating women with a variety of mood-altering tranquilizers, shock treatment or, in some instances, institutionalization, the advent of steroid hormone drug therapy would elevate menopause into the realm of legitimate medical concerns. Menopause, a natural process, would become pathologized and medicalized as an estrogendeficient disease.

It didn’t take long for the manufacturers of the burgeoning steroid hormone market to set their sights on the menopausal woman. In 1966 a New York gynecologist, Dr. Robert Wilson, wrote the first book enticing menopausal women to the medical wonders of estrogen. Feminine Forever extolled the virtues of estrogen replacement to save women from the "tragedy of menopause which often destroys her character as well as her health." He popularized the erroneous beliefs that menopause was a deficiency disease, the ovaries shriveled up and that estrogen replacement was a kind of long sought after youth pill.

Wilson singled out estrogen as the missing ingredient for the menopausal woman and pioneered the use of prescribing estrogen for a wide variety of symptoms. However, there had been no formal assessment of the safety of estrogen therapy nor were there any studies demonstrating the safety of its long-term use. The use of unopposed estrogen went out of vogue when it was revealed that it prematurely shortened the lives of its users. In 1975, The New England Journal of Medicine examined the rates of endometrial cancer for estrogen consumers and concluded that five years of use increased the risk sixfold. Women who had used estrogen long-term were 15 times more likely to develop endometrial cancer. Unopposed estrogen was identified as the only known cause of endometrial cancer.

Within a few years of the publication of Wilson’s book, not only was his early research into estrogen’s supposed benefits publicly condemned as flawed and invalid, but the FDA announced that Robert Wilson was an "unacceptable investigator."

Unfortunately, for the tens of millions of women who have been lured into the use of hormone replacement therapy in the hope of keeping them young forever, Wilson ’s theories and promises have since been proven completely wrong.

Hormone Myths
Hormones are very powerful substances. They are exceptionally potent chemicals that are made by the body in the tiniest amounts, in parts per billion or trillion. Begin tampering with nature’s finely tuned messengers of life’s processes and you are asking for trouble. This is especially true for women. A woman’s physiology and psyche are intimately connected to her monthly flow of hormones.

Hormones stimulate, regulate and control all vital bodily functions. They not only direct and determine physiological processes but also influence emotional and mental states.

A lot is said about the hormones, estrogen and progesterone. But what exactly are they? Estrogen really isn’t a single hormone. To be accurate it refers to a class of hormones with estrus activity (i.e. proliferation of endometrial cells in preparation for pregnancy). The key estrogens are named estradiol, estrone—both of which are implicated in stimulating abnormal cell growth when found in higher than normal amounts in the body—and estriol which is considered to be cancer inhibiting. Each type of estrogen has a different function in the body. These estrogens are produced mainly in the ovaries although small quantities are secreted from the adrenal glands, the placenta during pregnancy and in fat cells.

In the case of progesterone, however, we are talking about only one specific hormone. Thus progesterone is both the name of the class and the single member of the class. Progesterone is also made in smaller amounts by the adrenal glands in both sexes and by the testes in males. What is little known is that progesterone is the precursor hormone from which estrogen, testosterone and the adrenal cortical hormones are made. While all the attention has been focused on estrogen, it is actually progesterone that deserves a greater starring role in maintaining hormonal balance in women.

The synthetic hormones, estrogen and progestin, used in hormone replacement therapy are actually powerful steroid drugs. More accurately, hormone replacement therapy should be known as hormone drug therapy. At a conservative count, The Physician’s Desk Reference lists a combined total of approximately 120 potential risks and reactions associated with HRT. Synthetic progesterone also known as progestin such as Provera) is a man-made chemical and does not even exist in nature. It cannot be converted by the body into other steroid hormones unlike natural progesterone, the bio-identical form. Progestins are also riddled with serious side effects including cancer and cardiovascular disease. In fact, the National Institute of Health and the World Health Organization (WHO) have listed all synthetic estrogens as well as progestins as known human carcinogens.

Far from duplicating or supplementing nature’s hormones, the synthetic hormone components of HRT introduce powerful drugs into a healthy woman’s body, predisposing her to serious physical and emotional imbalances as well as potentially life-threatening conditions.

The Estrogen Deficiency Myth
At menopause, the amount of estrogen and progesterone being produced by the ovaries declines although other hormones continue to be produced. Estrogen levels drop to only 40–60 percent, just low enough so that the egg follicles do not mature, thus making pregnancy impossible. Contrary to popular belief, the ovaries do not shrivel up nor do they cease functioning. With the reduction of these hormones, menstruation becomes scantier and erratic and eventually ends. The official definition of menopause is one complete year without a menstrual cycle.

However, after menopause the ovary continues to be a productive endocrine gland working in conjunction with other body sites such as the adrenal glands, skin, muscle, brain, pituitary gland, hair follicles and body fat to produce estrogen (estrone), testosterone and androgens well into old age. A healthy woman never really stops making estrogen or progesterone.

Doctors who see the ovaries as useless after menopause point out that in women’s older years the ovaries grow smaller. However, as women age, the part of the ovary that shrinks is known as the theca, the outermost covering where the eggs grow and develop. The innermost part of the ovary, known as the inner stroma, actually becomes active at menopause for the first time in a woman’s life. With exquisite timing, one function starts up as the other winds down.

The female body is able to make healthy and symptom-free adjustments in hormonal balance after menopause, provided a woman has taken good care of herself during the premenopausal years, with proper lifestyle, diet and mental and emotional health. The appearance of menopausal symptoms are more indications of imbalance than an inevitable decline in health and function. By incorporating a healthy diet, nutritional support and positive lifestyle changes, symptoms of hormonal imbalance disappear. Hormonal symptoms are really symptoms signalling that the body is out of balance.

Adrenal exhaustion, thyroid problems, blood sugar imbalance, toxic livers, inflammation of the intestinal tract, food allergies, heavy metal toxicity and Candida are some of the health problems that contribute to hormonal imbalance.

What is coming to light is the fact many women actually have an excess of estrogen. "Estrogen dominance syndrome" is a term that describes a condition of an imbalance between estrogen and progesterone. The delicate balance between these two hormones is now skewed in estrogen’s favor. Stress, nutritional deficiencies, environmental estrogenic-like substances found in pesticides, herbicides and plastics are the likely contributing factors to the creation of estrogen dominance (as well as taking synthetic estrogens combined with an ensuing deficiency of progesterone).

The following is a list of symptoms that can be caused or made worse by estrogen dominance: acceleration of the aging process, allergies, breast tenderness, decreased sex drive, depression, fatigue, hair thinning, excessive facial hair, fibrocystic breasts, foggy thinking, headaches, hypoglycaemia, increased blood clotting (increasing risk of strokes), infertility, irritability, memory loss, miscarriage, osteoporosis, premenopausal bone loss, PMS, thyroid dysfunction mimicking hypothyroidism, uterine cancer, uterine fibroids, water retention, bloating, fat gain (especially around the abdomen, hips and thighs), gall bladder disease and autoimmune disorders such as lupus and MS.

Far from a deficiency in estrogen, modern menopausal women are much more likely to have an excess of estrogen.

The Perimenopause Myth
Research is now revealing that the ovary at perimenopause (the period of time from the first change a woman notices after age 35– 40 until one year has passed without a flow) is more active than it has been since adolescence. One leading researcher, endocrinologist Dr. Jerilynn Prior, has found that "the perimenopause ovary produces erratic and excess levels of estrogen, with unpredictable moods, heavy flow, hot flashes and mucous symptoms that appear suddenly and unexpectedly." The many symptoms that women experience during the perimenopause years, such as weight gain, irrational hunger, increased migraines, heavy periods, worsening endometriosis, breast swelling (with pain or lumps), new or growing fibroids, new or increasing PMS, pelvic pain and uterine cramps are caused by high levels of estrogen.

Dr. Prior has found that the average estrogen levels in perimenopausal women are higher than in younger women. The older women not only had higher levels of estrogen but also had lower levels of progesterone.

Many of these common health problems can be offset by increasing the level of natural progesterone. The problem is not always that progesterone levels are actually lower than normal but are low in comparison to elevated estrogen levels. Increasing progesterone levels using a natural transdermal progesterone cream (not a progestin) can alleviate, if not eliminate, most estrogen dominant symptoms.

These findings have also been supported by the work of Dr. Peter Ellison from Harvard University, who has developed a way to measure women’s ovarian hormones using saliva. He has reported his findings of ovarian hormone levels in various populations of distinct genetic, ecological and cultural backgrounds. He found that in Western populations premenopausal estrogen levels represent a high extreme of the spectrum and should be considered abnormal. Further, he suggests that these abnormal levels may relate to the current epidemic of breast and ovarian cancer. Saliva assay tests are far more accurate than blood serum tests to assess hormone levels.

Menopause Truths
Women are now faced with the challenge of redefining menopause. Menopause per se should be regarded as a normal adjustment reflecting a benign change in a woman’s biological life away from childbearing and onward to a period of new personal power and fulfillment. The Western perception of menopause as a threshold of undesirable symptoms and progressive illness due to estrogen deficiency is an error unsupported by fact. More accurately, menopausal problems should be viewed as an abnormality brought about by industrialized cultures’ deviation from a healthy lifestyle.

Increasing progesterone levels using a natural transdermal progesterone cream (not a progestin) can alleviate, if not eliminate, most estrogen dominant symptoms.

The hormone story is certainly a very complicated one. Up until now only one version of the story has been readily available to the majority of Western women. Serious doubt has been cast on the efficacy and appropriateness of estrogen and progestins as a treatment. Women are certainly suffering more than ever before from a wide variety of female complaints. What complicates the hormone story is that HRT, the seeming cure for these complaints, can actually make them worse. Without understanding the farreaching side effects of estrogen and progestins, doctors are often misdiagnosing the cause of these aggravated conditions. Other drugs may be prescribed with disastrous effects, as the spiral of unnecessary medication increases.

It is indeed time for women to take even greater responsibility for their health, their choices and lifestyle. It is also time to ask pertinent questions of health providers, to demand answers and to be willing to investigate safe, effective and natural alternatives. It is up to every woman to read, question, trust her natural instincts and learn about the workings of her own body. It is also essential that women honor their intuitive wisdom. After all, nature has fully prepared a woman to journey though all the stages of her life safely, effortlessly and naturally.

[Sherrill Sellman is the author of the bestselling book Hormone Heresy: What Women Must Know About Their Hormones. She is a contributing writer to many publications, a passionate women’s health advocate and an international lecturer.]

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