Q: I'm 50 and starting the "change of life." I'm very upset
that I can't make a decision about whether or not to take hormones. If
I don't take hormones maybe my bones will all shatter. But if I do take
hormones maybe I'll get uterine cancer. So maybe I should get a hysterectomy.
But I could still get breast cancer. Help!
A: These days, the post-menopausal phase may well be the longest of women's
increasingly longer lives. They may well live another 50 years without
menstruating. Which is, of course, why estrogen replacement therapy, breast
and uterine cancer, osteoporosis and the spectre of fractured hips are all
enormously important topics about which every woman must make decisions.
There are 3 types of estrogen:
- Estrone is the most carcinogenic form of estrogen; it increases at menopause.
It is formed mainly in the adrenals and ovaries. It is difficult for the
liver to break it down.
- Estradiol is the most active form of estrogen; it's what the patches
and Premarin are made from. Oral Estradiol (i.e. Premarin) turns into Estrone
in the small intestine. Estradiol is secreted by the ovaries. The body
recognizes and metabolizes it easily.
- Estriol is the least active form of estrogen; current research suggests
it may be ANTI-carcinogenic. This is the form of estrogen used in Europe
and China for menopausal hormone replacement. Two to 4 mg of estriol is
equivalent to the minimal dose of estrone - 0.6 to 1.25 - the dose taken
by most women on ERT. (Currently most women deciding about hormone replacement
therapy are making choices that include progesterone; the therapy is now
known as HRT.) Estriol is formed in the liver.
The task of the wild and lively crone is to prevent degenerative
disease, reduce the risk of cancer as much as is known how, continue to
take care of skin, exercise and sleep regularly, maintain good functional
bowel habits, plus two additional and critically important categories.
These are cardio vascular protection (heart disease is the number one killer
of both men and women) and maintenance of bone density. These issues will
be briefly discussed here one by one.
First, some MYTHS about Estrogen Replacement Therapy (ERT) and Hormone Replacement
- prevents aging of the skin
- prevents bladder or urinary problems
- relieves depression or other psychological symptoms
- increases sexual desire
- prevents heart disease
Some doctors recommend estrogen for all women (except those with a history
of breast or cervical cancer, or heart attack, stroke, liver disease, or
unexplained vaginal bleeding) at menopause, to continue for the rest of
their lives. Routine use of these powerful and potentially dangerous hormones
on healthy women is often unwarranted.
In general, ERT should only be used by women who have had their uterus removed.
Estrogen does play a role in preventing osteoporosis -- a thinning of the
bones that can lead to fractures of the vertebrae and hips in later life.
Estrogen may also be effective in preventing heart disease, which is more
prevalent in women who have early menopause. Its usefulness for healthy
women who have gone through a normal menopause is unclear. Young women
take note: Prolonged use of the "pill" (low dose estrogen/progesterone
for birth control) will likely increase a physiologic need for estrogen
later in life. This is because the organs which naturally produce female
hormones (primarily the ovaries, but also the adrenal glands, and the liver
which synthesizes and breaks them down) will atrophy and become less functional
when an outside source of hormones is taken. Explore other ways to control
fertility or menstrual irregularity, please.
What is clear is that estrogen causes cancer of the uterus - 5 to 14 times
as often in women who take it as in women who don't. It is also strongly
associated with an increased risk of breast cancer. When taken with progestins,
the increased risk of uterine cancer is canceled out. However, the addition
of progestins to estrogen for HRT may raise the breast cancer risk even
further. It may also cancel out estrogen's protection against heart disease
-- or it may even increase that risk. Current research suggests that progestins
alone, especially non-synthetic creams based on the Mexican wild yam, Dioscorea,
may be more effective than estrogen in reducing the risk of osteoporosis,
without the increased risk of uterine or breast cancer. More research is
Women who are plagued by hot flashes can benefit from short term use (maximum
of two years) of HRT, tapered off very slowly. Suddenly stopping therapy
will cause a return of the hot flashes. Women who suffer from vaginal dryness,
who do not respond to increased Vitamin E and essential fatty acids (such
as Flax oil), can use estrogen, applied directly in cream form. It should
be used only as often as necessary to correct the condition.
Bottom line based on what we know today: Women who are not at high risk
for osteoporosis need not expose themselves to the unknown risks of long
Risk Factors For Osteoporosis:
- family history of osteoporosis or hip fractures
- ovaries removed especially before age 40
- no full-term pregnancies
- small-boned, thin Caucasian or Asian women
- fair-skinned women
- sedentary lifestyle
- drinking more than moderately
- diet high in salt, animal protein, caffeine, soft drinks
- diet low in calcium and vitamin D
- hyperthyroidism, kidney disease, gastrectomy, long-term use of steroids,
glucocorticoids, anticonvulsants or antacids
The best way to maintain healthy bones may include some form of
progesterone, and possibly estrogen replacement, either by synthetic hormones
or plant medicines to potentiate the adrenals and maintain ovarian function.
Other than progesterone and estrogen, healthy bones need weight-bearing
exercise regularly. The very best kind is brisk walking, 1-4 miles daily
depending on stamina. The reason weight-bearing exercise is so important
in maintaining bone density is because the molecular components of the bone
float on and off continuously creating an electrical current which renders
the bone not only a structural support, but an electromagnetic sensing
system for the body. Appropriate physical stress increases bone formation.
There are, in addition, a number of nutrients which comprise the ingredients
for healthy bones, which should be taken as supplements. These include,
of course, Calcium -- about 500 mg daily, preferably in the gluconate or
carbonate form, and Magnesium (oxide) in an equal amount. Calcium absorption
requires sufficient gastric HCl. Calcium and Magnesium are best taken at
night, as they are smooth muscle relaxants. Vitamin D is also important
for keeping bones hard (not brittle) especially for people who don't live
in sunny climes. Boron is a critical trace mineral as is hydroxy appatite
(responsible for the crystalline formation in long bones). Make sure to
ingest sufficient protein and avoid phosphates (soda pop - use fresh juices
instead). Barbitruates and steroids (such as Prednisone) inhibit calcium
and Vitamin D absorption. Herbal bone protectors include Red Clover flowers,
Marshmallow root, and Horsetail reeds.
Heart disease is another complex topic, including congestive heart
disease, angina, coronary artery disease, and myocardial infarction. There
can be different problems with the valves of the heart, or the electrical
conduction system, or the blood supply to and from the heart, or the pumping
action of the four muscular chambers. In general it is crucial to avoid
substances and conditions which are toxic to the heart. These include hard
alcohol (any amount), excess weight, tobacco, uncontrolled infections and
unrelenting stress. Nutrients which support optimal cardiac function include
the amino acids Carnitine and Taurine (2 g daily), the enzyme CoQ10, vitamins
C, E, B1, B3 and B6, elemental Magnesium (1 gm daily) and the botanicals
Hawthorn berry (Crataegus oxycantha), Gingko biloba leaf, Cactus (whole
plant) and Lily of the Valley (Convallaria majalis).
Please note that each person is completely individual and the best approach
to optimal health by route of a clean diet and wisely chosen supplements
is to start a relationship with a trusted licensed primary health care provider.
Many medical doctors are under-educated in the field of nutrition and nutritional
supplements. Finding and maintaining optimal health is a life-long commitment.
Stay flexible and keep up with the news.
I urge you to join the National Women's Health Network to help monitor research
and bring accurate information to all women. "Taking Hormones and
Women's Health: Choices, Risks and Benefits" is a readable, detailed
35 page booklet summarizing all the latest studies on ERT and HRT. To receive
a copy of this booklet, send $7.50 to NWHN, 1325 G Street NW, Washington,
About The Author
A graduate of Bastyr University in Seattle, she completed both the Naturopathic and Acupuncture/Oriental Medicine programs. Her preceptor work (similar to residencies) took place in Seattle, West Virginia and China, with emphasis on gynecology, counseling, herbal medicine and naturopathic manipulation...more