"MENOPAUSE AND HORMONE REPLACEMENT THERAPY: what’s next"

The recent study of women using hormone replacement therapy (HRT,) performed by the National Institute of Health (NIH) and published by the Journal of the American Medical Association (JAMA) has women every where in a quandary. I have talked with women clients that have flushed their pills down the toilet vowing never put another pill in their mouth, to one client who’s female gynecologist told her she burned the article and took her pill. Extremes such as these will not help.

Closing our minds to the facts will only leave us more vulnerable. Rashly acting out our fears without cautious consideration may leave us with regrets in the form of osteoporosis, breast or ovarian cancers, stroke and heart attack- a high price for anyone to pay.

Women beset with the problems and frustrations of modern day life form groups for open discussion, sharing and support where everyone’s personal feelings are heard. We arm ourselves with the power of knowledge and then act. That’s what we do- and we do it well. Call it womanpower for lack of a better term if you like.

The history of medicine makes a fascinating read. It has all the stuff of a great novel: intrigue, mystery, great sacrifice, happy endings and sad endings, deception, horror, and some seemingly sci-fi twists. As with any new medical discovery, this one included history has some light to shed on the subject. Let’s take a look.

A woman living in pre-historic times would have been lucky to live to age forty. She never had more than two children because she would not have been able to keep up with the nomadic clan, a certain dead for her and her children at the hands of wolves or Siberian Tigers. She managed her body and her pregnancies carefully and knew the plants that would induce labor, relieve the pain of labor or cause abortion. She was in control of her body and since forty was old she never outlived her ovaries.

Fast forward to the middle ages and pre-modern medicine and you still find women living only to the age of forty to forty-five. Complications from childbirth and menstrual dysfunction prematurely took the lives of untold countless numbers of women. Men were now physicians and despite the use of midwifery women were loosing control over their bodies. She too never or very seldom out lived her ovaries. Beginning to sound familiar?

Fast forward again to the middle late eighteen hundreds and the early beginnings of modern medicine and you find men totally in charge. Life span had increased somewhat for men but many women still died giving birth or from some other mysterious menstrual disorder. Early surgical techniques did save some women’s lives if they were very young and strong and didn’t bleed to death. An older woman, say age thirty-five to forty barely stood a chance of surviving. The term hysterectomy (removal of a woman’s’ uterus) comes from the root word hysteria. The belief of the day; remove the woman’s uterus and you remove her hysterical emotions. Why do we not change this terrible name?

So what did our history lesson teach us? A woman’s reproductive system evolved to last about forty to fifty years. Therefore menopause is something new. We have given away control over our bodies to a medical system that cannot and does not have all the answers. We must accept the fact that we indeed need the knowledge of a trained professional but our final decisions will best serve us when based in our own female intuition as well as knowledge.

Stay tuned, next week I’ll be looking at the facts of this study, one I might add is not the first or possibly the best study out there. Till next time, Rebecca

part two

Last week we took a brief look at the history of a woman’s health and what had become the gold standard medical treatment for menopause- hormone replacement therapy (HRT.) This week we’ll take a look at this latest study that has caused such a fire storm of controversy regarding the long term use of HRT and its safety. Do we really know any more?

In July of this year the results of a study known as The Women’s Health Initiative (WHI) was published in the Journal of the American Medical Association. The study was funded by the National Institutes of Health (NIH) and studied 16,600 healthy women ages 50-79 for 5.2 years after which time they decided to cut short the original time frame of 8.5 years due to what they felt were rather definitive results damming the use of long term HRT. A second arm of the study continues to study women using just estrogen replacement therapy (ERT.)

As with most medical studies it’s boring and time consuming to read. The study was performed in the gold standard placebo double blind method which is medical jargon for neither participant nor researcher knew who was taking what.

The findings are a mixed bag of not so good, bad and not so bad. If you were using HRT to help stave off heart disease and stroke this study showed HRT of no benefit and may actually increase your risk. If you are using HRT to help prevent osteoporosis or colon cancer these statistics still look positive but the increased risk of breast, uterine and ovarian cancer is very real.

I commend anyone who is doing studies on women’s health, they’re long overdue but my curious mind makes me ask why this one is getting so much attention, especially when there are other studies that are longer and more comprehensive, namely the Harvard Nurses Study. This study first began studying women’s health in 1978; a second study of almost 85,000 healthy nurses began in 1989. Some of these same issues addressed in the WHI study were addressed in this study and countless other similar studies.

Other disturbing statistics this analytical mind picked out were things like yes, there is an increased risk for heart disease yet another study pointed out that women suffering first time heart attack that were using HRT had fewer fatalities. If you have a strong family history of osteoporosis or colon cancer how does one choose wisely then?

Most women begin taking HRT for the sometimes very disturbing symptoms of menopause but then never stop. After all they do protect our bones, sexual function, our sense of well being and a host of other important health issues that go along with aging.

Unless you’ve had college level statistics or spend time writing for grant money it can be hard to understand just how narrow (in spite of their broad sweeping statements) these studies can be. If you would like to have a look at the WHI study or other studies regarding HRT and menopause try The North American Menopause Society: NAMS.com. A great educational site I might add. If you are less confused then when you started, would you call me?

Stay tuned, next week in part three we’ll look at the female sex hormones of estrogen and progesterone and what the doctors are prescribing. Till next time, Rebecca

part three

Last week in part two of this series we looked at The Women's Health Initiative, the latest study and only one of many done regarding the subject of hormone replacement therapy (HRT). This week we'll take a look at the female sex hormones and synthetic replacements.

Somewhere around ages eleven- thirteen the female body will undergo a right of passage termed by the medical world as menarche. Her now fully developed ovaries are secreting enough estrogen to begin a monthly cycle that will last possibly into her late fifties.

The hormone estrogen increases the first two weeks of the month and builds a safe haven for an embryo if fertilization should occur. At mid month progesterone comes into play and if no fertilization has occurred this hormone will help the uterine wall shed it's nutritive layer to begin the cycle anew. There are many other hormones that will come into play inside of the usual one month cycle, but for this discussion we will stick to estrogens and progesterone.

This cycle will continue for the remainder of a woman's adult life (with the cessation of these two hormones) ending somewhere between the ages of forty and fifty-five depending on general health and genetics. Although we complain, these hormones in particular estrogen is the essence of who we are. It helps keep us young, fit, flexible and in general provides a feeling of well being.

Many healthy women enter their menopausal years with new enthusiasm for life. What is commonly referred to, as the change does not disrupt with major symptoms but rather minor annoyances. For others the physical and emotional symptoms night sweats, mood swings, roller coaster emotions are not tolerable and off to the doctor's office they go.

Premarin has been the prescribed synthetic choice for women over the years. It's a combination drug, estrogen and progesterone obtained from the urine of pregnant mares. This miserable truth is not widely publicized by the drug manufacturer.

Estrogen is an umbrella term for three forms of the hormone, esterase, estrodial and estriol. The body will convert the first two into the lesser and non-toxic estriol. Premarin as well as other synthetic estrogens are mostly esterase the most powerful form of the hormone and is linked directly to the increased risk of cancer with long term use.

Many women opt for transdermal delivery of hormone replacement with a simple skin patch. Transdermal patches are a somewhat safer choice for a couple of reasons; the amount of estrogen delivered is a lesser dose and the estrogen is then absorbed directly into the blood stream bypassing the need for the liver to detoxify any residual drug.

There are natural forms of estrogen that doctors are beginning to prescribe. Chemically they are in the non-toxic estriol form and can be used safely. These unfortunately are not main stream and many doctors are not willing to use them. Possibly in the light of these new studies they will become more interested in prescribing them.

If you are considering HRT for issues of menopause these drugs can be used safely for the short term without the concerns of increased risk of cancer. Unfortunately the trade off with synthetic hormones are the side effects including increase in weight, water retention, blotting, intestinal upset and headache.

Next week in the final part of this series we'll take a look a more natural approach to hormone replacement using foods and herbal therapy.

Till next time, Rebecca