Alternatives to HRT
By Andrew Gaeddert
In the popular 1966 book Feminine Forever, Dr. Robert A. Wilson, a gynecologist, used disparaging descriptions of aging women (flabby, shrunken, dull-minded, desexed) to upend the prevailing idea of menopause as a normal stage of life. “Women and their physicians,” Dr. Wilson wrote, “should regard menopause as a degenerative disease that could be prevented or cured with the use of hormone drugs.”
“No woman can be sure of escaping the horror of this living decay,” Dr. Wilson wrote. “There is no need for either valor or pretense. The need is for hormones.” It is believed that Dr. Wilson came up with the concept of hormone “replacement” therapy (HRT). While drugs may effectively treat hot flashes, there is no evidence that women need hormonal drugs during menopause.
As the popularity of estrogen grew, an increasing number of women developed cancer of the uterine lining, the endometrium. Two studies published in the mid-1970s in the New England Journal of Medicine reported that taking estrogen therapy had increased the risk of endometrial cancer by at least five times. In 1980, researchers at Boston University Medical Center estimated that the use of hormone therapy had caused more than 15,000 cases of endometrial cancer (often-termed uterine cancer) in the United States between 1971 and 1975 alone.[i]
By the 1990s, millions of American women were told, by gynecologists, medical associations, and drug companies that they could help their bodies ward off major illness by taking menopausal hormone drugs. Hormonal drugs were recommended to not only stop hot flashes and night sweats, but also for heart and bone health. Then the evidence came in.
The WHI Estrogen-plus-Progestin Study was stopped in July 2002, when investigators reported that the overall risks of estrogen plus progestin, specifically Prempro™, outweighed the benefits.[ii] The researchers found that use of this estrogen-plus-progestin pill increased the risk of breast cancer, heart disease, stroke, blood clots, and urinary incontinence. However, the risk of colorectal cancer and hip fractures was lower among women using estrogen plus progestin, than among those taking the placebo.2 In addition, the WHI Memory Study showed that estrogen plus progestin doubled the risk for developing dementia (a decline in mental ability in which the patient can no longer function independently on a day-to-day basis) in postmenopausal women age 65 and older. The risk increased for all types of dementia, including Alzheimer’s disease.[iii]
The WHI Estrogen-Alone Study, which involved Premarin™, was stopped in February 2004, when the researchers concluded that estrogen alone increased the risk of stroke and blood clots. In contrast with the WHI Estrogen-plus-Progestin Study, the risk of breast cancer was decreased in women using estrogen alone compared with those taking the placebo. Use of estrogen alone did not increase or decrease the risk of colorectal cancer.[iv] Similar to the results seen in the Estrogen-plus-Progestin Study, women using estrogen alone had an increased risk of urinary incontinence and a decreased risk of hip fractures.
Observational studies have shown that estrogen and estrogen plus progestin is associated with increased risk of ovarian cancer. It is believed that menopausal estrogen use by women who have already been diagnosed with breast cancer, may promote further tumor growth, however studies have produced conflicting results. Survivors of other gynecological cancers may be putting themselves at risk by taking hormones, as these cancers are often hormone dependent. For women who don’t wish to take hormones, exercise, stress reduction and eliminating alcohol and smoking can decrease the risk of chronic disease. Hot flashes and night sweats can be effectively be treated with NuLignan™, derived from spruce trees, and the traditional Chinese formula Great Yin™ (du bu yin), while women with a constellation of menopausal symptoms including insomnia, migraine, low back pain, vertigo, depression, five-palm heat, and lowered sex drive, can be treated with Three Immortals™. Taking calcium and vitamin D can preserve bone mass while BioStrong™ contains a mineral proven to increase bone density and prevent fractures. OsteoHerbal™ is an empirical Chinese herbal formula with ingredients shown to support bone health, reduce fracture risk and to support balance.
- [i] Singer, Natasha, Wilson, Duff. Menopause, as Brought to You by Big Pharma. New York Times online. December 12, 2009 http://www.nytimes.com/2009/12/13/business/13drug.html?_r=1&pagewanted=2. Accessed on 3/11/10.
- [ii] Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women’s Health Initiative randomized controlled trial. Journal of the American Medical Association 2002; 288(3):321–333. http://www.cancer.gov/cancertopics/factsheet/Risk/menopausal-hormones#r1 Accessed on 3/10/10.
- [iii] Shumaker SA, Legault C, Rapp SR, et al. Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: The Women’s Health Initiative Memory Study: A randomized controlled trial. Journal of the American Medical Association 2003; 289(20):2651–2662.
- [iv] Anderson GL, Limacher M, Assaf AR, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: The Women’s Health Initiative randomized controlled trial. Journal of the American Medical Association 2004; 291(14):1701–1712.