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by
Dr. Karen Jensen, N.D.
Today
more and more menopausal and perimenopausal women are seeking safer
alternatives to Hormone Replacement Therapy (HRT), the standard treatment
for menopause symptoms, particularly now with the recent findings of a
long-term controlled clinic trial. The Women’s Health Initiative study (WHI),
recently published in the Journal of the American Medical Association (JAMA),
found the combined drugs, estrogen and progestin, increased the risk of
invasive breast cancer by 26%, a 41% increase in strokes, a 29% increase
in heart attacks, and doubled rates of blood clots in the legs and lungs.
This is not the first study to show increased risks, but it is the first
one the scientific community is listening to.
Information about the
risks of HRT has been available since the 1960s, with more recent studies
such as The Collaborative Group on Hormonal Factors in Breast Cancer
study. The results, reported in 1997, found that after five years of
estrogen use, women’s risk of developing breast cancer increased by 35
percent, and the extra risk did not disappear until five years after
stopping estrogen use. The Nurses’ Health Study, organized by Harvard
Medical School followed 122,000 nurses for 16 years and similar statistics
were reported.
Further, how many women
on the birth control pill or women on HRT realize that the development of
abnormal blood clots is the most common serious side effect of the use of
estrogens, particularly during bed rest? Women are generally not advised
to stop taking estrogens for at least three to four weeks before surgery,
two weeks after surgery or when there is a need for prolonged bed rest,
and very few women of any age are told of the incredibly high risk of
cardiovascular disease that comes with combining smoking and estrogens.
While doing the research
for my menopause book, I found that the risks associated with estrogen use
increase even more if the general health status is poor. Before using any
hormones the Canadian Compendium of Pharmaceuticals (CPS-the reference
manual for Canadian pharmacists on risks of drugs) recommends that all
patients should undergo the following medical tests: blood calcium levels,
blood glucose levels, endometrial biopsy, Pap test, lipid panel (HDL, LDL,
triglycerides and total cholesterol), liver function and thyroid tests,
hormone levels and a complete physical examination including blood
pressure, breast and pelvic exams. And, that the tests should be repeated
every six months if the woman is taking hormones.
In my clinical practice
I find that few, if any women, have had these tests recommended before or
after they are prescribed HRT.
Yet, the promotions
still continued. In Canada HRT is the third most prescribed drug therapy
with over 12 million prescriptions written in 2001 and in the U.S. over 22
million prescriptions were written in 2000. "Estrogen, don’t leave
home without it" became the menopause motto. And now, low and
behold, HRT studies were halted due to the increased risks for breast
cancer. Why did it take so long?
Menopause is not a
disease requiring decades of drug therapy (HRT), but rather it is a
natural process every woman will experience eventually. Many women
experience unwanted symptoms related to the ovaries taking a well-deserved
holiday during this hormonal transition.
During perimenopause and
menopause the ovaries start to decrease the production of estrogens and
progesterone and other organs of the hormonal system are meant to buffer
this transition. Many women today are so physically drained and
nutritionally compromised that the support organs cannot respond to the
extra demands and, as a result, they experience different, often
unpleasant symptoms.
Some of the common
symptoms blamed on menopause are: night sweats, hot flashes, insomnia,
fatigue, weight gain, decreased libido, brain fog and emotional changes.
As a naturopathic physician I would treat the cause of the individual
symptoms. Imbalances in the adrenal glands, thyroid, liver or the
intestines are most often the cause of menopausal related symptoms.
There are also many
environmental influences that have a negative effect on the hormone
systems of men, women and children. Literally thousands of chemicals found
in the environment – PCBs, pesticides, polycarbons used in many
plastics, chlorine-containing compounds (yes, chlorine in drinking water)
and synthetic estrogen metabolites that enter the water supply via the
urine of women taking synthetic estrogens – all resemble the human
hormone estrogen. These estrogen impostors are called xenoestrogens. Their
molecules are similar enough to human estrogens to fit the same cell
receptor sites – the estrogen parking spots thereby creating estrogen
dominant conditions such as breast cancer, endometriosis, fibroids,
infertility, male feminization, premenstrual syndrome and many of the
menopausal symptoms.
There is protection
available from these estrogen-like impostors. Plant foods contain
phytoestrogens in one form or another and they are considered hormone
balancers since they exert very mild estrogenic effects and antiestrogenic
activity. These weaker plant hormones compete with more potent steroidal
(made by ovaries) and xenoestrogens for the parking spots in the body. By
taking up more of the estrogen parking spots, the phytoestrogens reduce
the overall activity level of the more potent estrogens. Many researchers
feel this is why women in cultures consuming predominantly plant-based
diets rarely experience menopause-like symptoms or estrogen dominant
conditions. Foods sources of phytoestrogens include: flax seeds, soy
foods, lentils and chickpeas.
The liver and the
intestines play a very important role in the successful elimination of the
excess potent estrogen impostors. The liver is responsible for the
coupling of the excess hormones to other agents, and these couples are
then excreted through the bile and eventually end up in the intestines. If
the intestinal milieu is healthy, these couples stay together for the long
journey out of the body. However, if the microbial milieu is out of
balance, these couples become separated and the hormones re-enter the
bloodstream and keep re-cycling.
The recycling of the hormones, those made
by the body along with the influence of xenoestrogens, often leads to some
of the undesirable estrogen-dominant conditions mentioned above. There are
effective liver support remedies such as dandelion, milk thistle, curcumin
and indol-3-carbinol that can help detoxify the excess hormones from the
liver and something as simple as adding probiotics to the program for the
intestines, would be very beneficial.
Traditionally women have
used herbs such as black cohosh, red clover, chastetree (vitex), hops or
don quai to help support hormonal changes, and these herbs can be taken
individually or in combination formulas such as menosense or meno.
For those women who are
currently taking HRT and would like to ‘switch’, it is generally
recommended that you wean off the hormones gradually and support the
transition with herbal products. Above all, the foods we choose to eat,
physical exercises and spiritual exercises are the most important aspects
of good hormonal health.
Rather than continually
waiting for "new and improved" drugs that offer better health
through chemistry, let’s get back to basics and start taking more
responsibility for our own health and our environment. We need to learn to
appreciate and respect the interconnectedness of each and every aspect of
our physical, mental, emotional and spiritual levels.
Dr. Jensen is author of No
More HRT: Menopause, Treat the Cause and The Complete Athlete with
clinics in Vancouver 403-742-0800 and Calgary 403-287-9201.
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