Part 1
Hormone Replacement Therapy: When is it Necessary?
Part 1 of 5 (Part 2, Part 3, Part 4, Part 5)
By Tim O’Shea
Before researching the topic of estrogen, I admit my initial preconceptions about hormone replacement therapy for menopause were less than brightness and trust. The usual pattern seems to be:
- research studies funded by the same companies who propose to sell the drugs
- no conclusive positive results from controlled, randomized clinical trials
- A Drug In Search of a Market
- major side effects from the new drug therapy that are chalked up to the “disease” itself
Guess I’m jaded. So sue me.
Trying to prove my preconceptions wrong, the research failed me. Anyone can see how the whole thing was set up. Now this chapter is not light reading, even though I tried. But if you are a woman, you need to read the whole thing. After that, you’re on your own.
Drug Hoax Phenomena Are Not New
The same thing happened in the Boer War (Hadwen), in the Philippines in 1905 (Hume, p 200), and in Desert Storm. Mass administration of drugs that killed many more people than they saved. The difference here is that today the control of information has become much more sophisticated, the focus being trust your doctor, trust your doctor – you really don’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 vertically integrated boom market.
Here’s The Basic Story
Since the 1930s, American women have been trained and bullied into 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 throughout history up to the present time muddle through it? How do Third World women or non-HMO lifestyles survive the ordeal? Keep those two questions in mind when you read anything mainstream, either advertising or articles.
The “new” “medical condition” requires drug therapy, which coincidentally has just recently been “discovered”: synthetic estrogen – hormone replacement therapy. Does it work? Are women better off now? Does it really prevent osteoporosis? Read on!
What Is Menopause?
Menopause is a period of years in a normal woman’s life in which gradual hormonal changes bring about a shift away from the physical powers of childbearing, in favor of a more mature condition of mental development and wisdom.
The unpleasant symptoms we have come to associate with menopause are common only in a small group of women in history: American and Northern European women in the past 75 years. Outside that group, menopause is not so problematic and is taken more in stride as a natural phase in a woman’s life, with little 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 low income. 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 popularized by marketing and advertising – the foods of commerce. (Royal Lee)
Less need to exercise, more focus on money, greater stress – the basic formula for the rise of the most resistant group of diseases in history : the degenerative diseases. Heart disease, cancer, arthritis, diabetes, osteoporosis – are epidemic 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 the Himalayas called Hunza Land, famous for longevity to 120 years old. Two Americans, Dr. Allen Banik and Renee Taylor, visited this isolated mountain civilization, one in 1958 and one in 1962.
Both wrote books describing their incredible experiences. Both detail the simple diet as well as the lack of degenerative diseases, and infectious diseases as well. Physically cut off from the world by treacherous mountain passes, the Hunzas developed their own agriculture system of stone terraces, fed by the mineral rich waters of the glaciers. Hunza health is 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, unrefined diets, there is no word for “hot flashes.” As we shall see, the unpleasant symptoms of menopause are directly related to the amount of estrogen a woman has maintained during her adult life, prior to menopause.
Natural phytoestrogens (plant-estrogens) are found in plants like licorice, soybeans, alfalfa, and many others, in very small amounts. Phytoestrogens are weak estrogens and block the stronger forms. A diet abundant in phytoestrogens before menopause will do much to moderate the day-to-day estrogen level so that when menopause arrives, there will not be such big drop.
The Creation Of A Market:
How Did the 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 shall see. Dobbs first thought DES would solve the problems of menopause, but the AMA immediately began to make extravagant predictions for “preventing miscarriages” and solving all problems of pregnancy as well. (Robbins, p138)
After many years, DES was being prescribed for a “safe pregnancy” and to “prevent miscarriages.” By 1960 it was found that between 60 and 90% of DES daughters had abnormal sex organs, leading to high rates of infertility, miscarriages, and cervical cancer. (Sellman p28). DES sons commonly had testicular dysfunctional and were often sterile.
As for the mothers who had taken DES, their risk of breast cancer had been increased by 40%. (Meyers p 143) DES was the first drug ever invented that could cause cancer in the offspring when taken by the mother. (Reusch, p 22) But still the drug wasn’t taken off the market until 1971! ( Kamen, p99). By that time the industry didn’t need DES any more for its bottom line, because ERT was off and running.
Next Contestant
Public attention was then diverted away from the disasters of DES by a 1966 best seller called Feminine Forever, by Robert Wilson, a New York gynecologist. Wilson’s thesis was that menopause is an estrogen-deficiency disease. All the unpleasant symptoms which accompany menopause were the simple result of too little estrogen. Insufficient estrogen supposedly caused a woman to lose her youth, beauty, cheerful attitude, and bone density all at once, with the onset of menopause.
Not missing a beat, the drug industry immediately donated $1.3 million to set up the Wilson Foundation for the sole purpose of developing and promoting estrogen drugs. The usual story: limited studies with inconclusive results, skewing results to please the company that was paying for the trials, discontinuing studies that weren’t turning out “right” …
The primary study that was the basis for vaulting synthetic estrogen into the limelight, originally as a contraceptive, was a small, flawed trial done in Puerto Rico, in which 20% of the 132 women suffered serious side effects. Five of them died.
Negatives were swept under the carpet as irrelevant – the main thing was that the new wonder drug supposedly cancelled the “horrible” symptoms of menopause – hot flashes, vaginal dryness, migraines, etc. FDA approval for synthetic estrogen was given based on this one study! (Marshall) Throughout 1964 and 1965, fueled by the advertising power of the biggest clients, articles appeared in major women’s magazines, like Vogue, Cosmopolitan, and Good Housekeeping proclaiming a breakthrough that would finally set women free from the ravages of the dread menopause. (Lee p24)
Within a few years, with no real proof that Wilson was right, with superficial clinical trials, synthetic estrogen was being popularly prescribed, and a new industry was off and running. They called it Estrogen Replacement Therapy. Better living through chemistry.
A Little Snag Came Up In 1975
The New England Journal of Medicine (Dec 1975 p.1199) published its findings after studying the causes of endometrial cancer. They showed that women who took the new estrogen drugs had just increased their risk of endometrial cancer by a factor of five times. Unless they had been using the drugs longer than seven years. Then it was 14 times the normal incidence.
Sales slowed
Yankee ingenuity to the rescue: it was found, though not conclusively, that rates of endometrial cancer could be reduced if synthetic progesterone were added to the synthetic estrogen. Synthetic progesterones are called progestins. So they changed the name from Estrogen Replacement Therapy to Hormone Replacement Therapy, and the show went on. Sales climbed back up, and then continued to grow. And grow.
With similar results to the 1975 study, 20 years later the American Cancer Society conducted a huge 13-year study of some 240,000 postmenopausal women to find the relation between HRT and cancer. Their findings: 40% higher incidence of ovarian cancer; after 11 years of HRT, the figure went to 70%! (Rodriguez)
How Could This Be?
As the HRT industry gained strength, the manufacturers began to make additional claims about the benefits of HRT, claims that were again unsupported by solid research:
- HRT could prevent osteoporosis
- HRT could prevent heart disease
The underlying, and unproven, assumption of this new “therapy” – HRT – was that women’s lives were being improved now that they were spared the horrors of aging, menopause, osteoporosis, and the loss of femininity. Unfortunately, these promises are rarely kept, and almost never because of a program of synthetic hormones.
Worse, the side effects of HRT have proven to be a bigger problem than what they were supposed to cure.
To begin to untangle this giant web of doubletalk and wrong information, we have to look at some basic endocrinology: Can’t tell the hormones without a program. If this gets too complicated for the attention-challenged, just skip to the next section, but at least give it a try.
Hormones
They are chemical compounds that are players in the most sophisticated and exquisitely balanced internet in the entire body: the endocrine system. This group of glands, including the adrenals, the pituitary, the ovaries, the testes, the thyroid, and the hypothalamus are interrelated in impossibly complex ways, about which we’re just beginning to get glimpses of understanding.
It’s a swirling universe of chemical elegance and precision, involving millions of refined little molecular firings which wink in and out of existence every second. “Touch one strand and the whole web trembles,” is the way endocrinologist Deepak Chopra puts it. The endocrine system controls all other systems of the body by means of chemical messengers, who wait for an answer.
What Is Estrogen?
Estrogen is a hormone, one of the moving parts of that endocrine system. It is a steroid (made from cholesterol) hormone, occurring in both men and women.
Estrogen’s functions are primarily the growth and development of sex organs and other tissues related to reproduction (Guyton p1023)
For a basic overview of one little part of the endocrine system, 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 show a little corner of the complex give-and-take between hormones, how a change in any one hormone in this chart can affect many others. Lee and Chopra both speak of the dance of the hormones, the delicately interwoven choreography, about which we have only the most rudimentary knowledge.
We’ve begun fooling around with this highly tuned endocrine system because we’ve discovered a few coarse, synthetic, sledgehammer substances that resemble real estrogen, or real thyroid hormone, or real progesterone. But we really have only the vaguest notion what we’re doing, because of all the overlapping interrelationships. Our ignorance has 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:
- estriol
- estradiol
- estrone
From here on out in this chapter, “estrogen” as is produced by the body refers to all three of the above hormones.
Estrogen is produced in three main places in a woman’s body:
- the ovaries
- the adrenal glands
- the fat cells
The main purpose of estrogen is to make the uterine lining, the endometrium, ready to implant a fertilized egg in the event fertilization occurs. To aid in this function, estrogen will promote
- water retention
- fat storage
- maturation of the female adolescent
All the above is OK if pregnancy is likely. But excess estrogen throws off the timing. Excess estrogen causes the body to prepare for embryo implantation all the time. This state of over-preparation is the cause of
- sluggish blood circulation
- migraines
- increased clotting
- high stroke risk
- disrupted copper/zinc ratios in brain cells/ mood swings
- fibroids
- endometriosis
Every system in the body has a feedback loop to keep balance. Estrogen has a sister hormone called progesterone, whose functions are equally important.
