From the very day it enters a woman's mind that replacing hormones is something she should think about, she will immediately enter a zone of conflicting information and loose facts and prejudices from the media, her friends, her internist, her gynecologist, or her mother, all mixing together with her own preexisting ideas into a confusing stew. So before we can even begin to discuss our plan, we need to clear away some misunderstandings and misinformation.
"Taking estrogen is dangerous." How many women have you heard say this? If we could single out the most damaging consequence of the controversy over HRT, it would be that estrogen--this essential life-enhancing friend to your body--has become for many women a dirty word.
What Is "Estrogen"?
Since the first hormone replacement drugs were put on the market over fifty years ago, it has become an ingrained practice to use the word "estrogen" indiscriminately for both the estrogen your body produces and a wide range of diverse hormonal preparations. Drug companies with hormone replacement products have contributed significantly to the confusion by continually referring to their products as simply "estrogen."
A woman will tell a friend that she is taking estrogen, thinking she is ingesting a single substance called estrogen that conforms to the hormone produced in her own body. But estrogen is, in fact, not a single hormone but a family of hormones, consisting principally of estrone (E1), estradiol (E2), and estriol (E3). Along with these three principal estrogens, we know that there are at least two dozen(1) identified estrogens produced in a woman's body, and researchers may well discover others. Premarin contains 48 percent estrone (natural to humans) and 52 percent horse estrogens (natural to horses). It also contains additives that are foreign to a woman's body. None of the American drug products contain estriol (E3), which has been used widely in Europe for over fifty years, and which new studies have shown to be cancer preventive.(2) Estriol, the estrogen most dominant during pregnancy, has particular benefit for women who are at risk for breast cancer and need hormone balancing and replenishment. In Europe, it is particularly favored for use in vaginal preparations, such as Oevestin. The reasons for its being completely ignored in the United States until recently will be discussed at greater length in chapter 6.
Most media reporting contributes to the confusion over "estrogen" by failing to make clear which estrogen they are referring to or to make distinctions as to what specific products are being discussed or tested. None of the mainstream media articles reporting the recent studies of increased incidence of breast cancer in women on HRT mentioned the fact that the subjects had used Premarin. Of the three principal estrogens circulating in a woman's body, the one predominantly implicated in increased cancer risk is estradiol. Premarin, as noted, is formulated with estrone, which converts to estradiol. Estriol, as we have just mentioned, has cancer-preventive properties. So when the results of studies are announced that show increased risk of breast cancer in those women on HRT, it is unfortunately estrogen that is
demonized and not the specific products tested.
The fact is, you cannot live without estrogen. Estrogen is not merely a "sex" hormone, as there are presently three hundred known functions for estrogen in the body and we are only beginning to understand all its interactions. Every cell in your body has receptors--what you might think of as little landing docks--that receive the complex hormonal messages circulating through your blood. There are estrogen receptors in all your vital organs--such as your brain, your heart, and your liver--and all through your body. Estrogen spurs the production of an important enzyme in the brain that helps the connections between brain cells to flourish. It is estrogen that helps maintain verbal learning and enhances a woman's capacity for new learning.(3) Indeed, estrogen supports you from birth until death.
Ironically, most of the studies relating to HRT products have gone very far to show what an important role your own naturally produced estrogen plays in the functioning of your body. But in its rush to give women the benefits of estrogen, the medical/pharmaceutical establishment has simply continued to promote the standard hormone products now available from the major drug companies without looking for better and safer alternatives that also don't have the negative side effects of the standard drugs.
Does "Estrogen" Cause Cancer?
Almost all the studies that link estrogen to an increased risk of cancer have been related to taking Premarin or other common drug products. Premarin is extracted from horse urine. While it contains helpful estrogens like estrone and estradiol, it also contains equilin and equilenin (horse estrogens) and synthetic additives. It is the taking of unbalanced and foreign estrogenic elements and additives that we believe is dangerous and potentially cancer producing, not estrogen itself. When used appropriately, the estrogen from natural plant sources, which matches your own hormones exactly, does not produce harmful side effects.
Standard medical practice prescribes drugs using the so-called risk/benefit factor. The side effects of a drug are medically accepted hazards of treatment: The judgment is made that the benefits outweigh the risks, and doctors are willing to accept the fact that you may suffer serious consequences. But are you willing to accept it?
A major link between raised estrogen levels and breast cancer is primarily a ratio problem--the ratio between estrogen and progesterone in your body, which can be brought on by poor diet, poor digestion, lifestyle habits, stress, or environmental factors. In the simplest terms, unbalanced estrogen-to-progesterone levels can cause a relative or absolute "estrogen dominance," which can lead to the proliferation of cancer cells. When the first hormone replacement drugs were put on the market, the symptoms of menopause were understood primarily in terms of "estrogen deficiency," but this has since proved to be a narrow vision. This erroneous medical model takes one hormone, estrogen, out of context in the body's functioning, and neglects the importance of progesterone. Just by correcting diet and digestion, you can decrease your environmental exposure and improve your body's ability to balance estrogen and progesterone and eliminate estrogen dominance. A plant-rich diet helps eliminate estrogen dominance and is actively anticarcinogenic.
But I Love My Premarin
On the other side of the aisle from those women who have an undifferentiated fear of estrogen are those women who simply continue to take Premarin or Premarin/Provera or the other commonly prescribed HRT drugs and shut their ears to all controversy.
Let us say right up front that we are not against "hormone replacement" per se, although what we are advocating could more accurately be called hormone balancing or replenishment. When it comes to dealing with temporary symptoms, such as hot flashes, night sweats, and vaginal dryness, Premarin has been shown to be effective. But we do think it is a crude product--crude in the sense that it was developed during the early stages of hormone investigation and contains estrogens foreign to a woman's body. We think this lack of conformity to a woman's body is what contributes to its side effects.
Those women who are able to tolerate Premarin can go on taking it for years--well past the five-year mark that most studies consider a critical period--all the while harboring the worry that if they go off it, the chassis will start to break down and various parts will begin to fail or fall off. These women face a difficult dilemma: If the drug they are using seems to be working, it's hard to consider a change. But ignoring the potential for harm can be dangerous to your health.
To add another complication, Premarin and its sister drugs are now being advertised as necessary to ward off osteoporosis and heart disease, opening up a whole new marketing strategy to sell these drugs to you for long-term use. When they were first put on the market, the primary emphasis was on short-term treatment of temporary symptoms, but by advocating use of these drugs for long-term use as prevention against heart disease and osteoporosis, a whole new element of danger and confusion has been added.
The Profit Motive
Why haven't the makers of standard HRT drugs sought out safer alternatives? In the case of Premarin, 940 million dollars and growing is the answer. Premarin is the number-one best-selling drug in the country.(4) Why haven't American pharmaceutical companies strongly marketed these safer bio-identical plant-derived hormone products? Simple. They can't be patented, which means that no single company can corner the market. And since research money will flow only to those projects that will provide a drug company with so-called protected profit, "natural" will always lose to "synthetic" in the pharmaceutical world.
Since the late 1800s, U.S. law has allowed medicines to be patented only if they are not natural substances. If, for example, a pharmaceutical company decides to market a natural substance, another competing company could ride on its coattails and dilute its profitability, hence the notion of creating drugs with protected profit. Many natural substances are changed into patentable drugs simply by changing a few molecules of the natural substance. The decision to do this is often not driven by the desire for a better drug, but rather for one that is different enough to obtain a patent.
But what seems a tiny change in the molecular structure of a substance can make a huge difference in its effect on your body. Adding or subtracting a few hydrogen atoms and a few double bonds in the biochemical structure of estrogen or testosterone is the difference between a male and a female! In the case of Provera, which is a molecularly altered version of natural progesterone, side effects can result because the body doesn't recognize the substance as completely biologically identical to one in your body.
Fortunately, switching to the plant-derived bio-identical hormones can be done with relative ease. A woman taking Premarin can have an equivalent dose worked out for her by a pharmacist, and she can immediately start taking the plant-derived hormones.
How "Estrogen" Got Politicized
Unfortunately, and for many of the wrong reasons, not supplementing estrogen has become a political cause for some women.
Betty Friedan has taken a strong position against women using HRT. She is also quoted as saying, "I may have had a hot flash, one hot flash, while I was giving a major speech in the middle of the seventies,"(5) implying that women who took anything for menopause were sissies, and dismissing the significance of the menopausal passage altogether.
Well, Friedan is one lucky woman if she only had one hot flash she can barely remember. It probably means she has naturally favorable hormone levels either because of good genetics or her diet, and she is apparently among the 25 percent of women who sail through menopause without symptoms.
But what about the other 75 percent? These women are not as fortunate. Whether because of a complete hysterectomy, or just having their ovaries removed, less favorable genetics, a poor diet, or high stress levels--just to mention a few of the possibilities--these women can become noticeably and often severely symptomatic.
One third of women in this country have had hysterectomies (a shocking number, which we will talk about in a later chapter), and all of these women have suffered a hormonal "disruption" of some magnitude and will need help in balancing.