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HEALTH CONCERN? BioHealth Health Concerns

Women's Hormones

Contributing Author: Kalish, Daniel D.C.

Daniel KalishFor two decades Daniel Kalish, D.C. has successfully treated patients with hormone imbalances, food cravings, fatigue, depression, digestive distress, and many other health complaints. Dr. Kalish founded The Natural Path Clinic California, where he led a staff of physicians, nutritionists, chiropractors, psychotherapists, physical therapists, personal trainers, massage therapists and acupuncturists for more than ten years. He currently maintains an active international phone consultation practice with patients and trains physicians in natural medicine. He has designed health programs for countless professional athletes including the world’s top skateboarders, hockey players, elite runners, tri-athletes, golfers, tennis players and world-class weight lifters. Download his ebook Your Guide to Healthy Hormones.

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Menopause is a natural transition ending the body’s childbearing phase, and has been around for as long as women have. But it has not caused women at all times and in all places the kinds of complications we associate with it today. In the West, menopause was simply not talked about in polite company — until recently. Alarm over the dangers of hormone replacement therapy have brought the topic out in the open and cast a sharp light on the medical establishment’s abysmal failure to address an issue that all women will encounter in midlife.

The conventional Western view of the female reproductive system becomes evident from the vocabulary used to describe it. The essential female hormone estrogen derives from the Greek estrus, meaning “frenzy.” The Greek word for uterus, hystera, forms the root for hysterical. Little has changed in terms of linking “female trouble” with insanity over the centuries, now under our current medical model we typically tie menopause in to depression and prescribe antidepressants.

In 1966 the first highly influential book on the use of synthetic hormone replacement therapy (HRT) was published, Feminine Forever. Its author, Dr. Ronald Wilson, had his research and book paid for by Wyeth, the pharmaceutical company that manufactures the drug Premarin. A prominent gynecologist, Wilson received funding to start a research organization that legitimized the use of hormones for treating problems associated with menopause.

Wilson’s attitude toward menopause represented no great leap forward. In Feminine Forever, he describes menopause as a “living decay” in which women descend to a “vapid cow-like state.” His best-selling book promoted Premarin as a panacea for this deplorable fate, and Wyeth ignored the questionable methods used in Wilson’s research.

By the early 1970s, the synthetic estrogen supplement Premarin had become the all-purpose treatment for menopause, and it continued to be prescribed widely for the next 30 years, despite a study in 1975 that linked estrogen supplement therapy (ERT) to uterine cancer. This finding stalled the ERT bandwagon only briefly. Adding progestins to the mix – synthetic progesterone – resulted in a drug that was considered safer, and ERT became the more comprehensive hormone replacement therapy (HRT) still taken by millions of women in this country.

Two Disturbing Studies
It wasn’t until July 2001 that the risks of synthetic hormone replacement became widely known. An eight-year government-funded study of more than 16,000 American women by the Women’s Health Initiative showed that Prempro — the synthetic hormones Premarin plus Provera — were shown to increase the risk of breast cancer by 26 percent, heart attacks by 29 percent, and stroke by 41 percent, while more than doubling the risk of blood clots and pulmonary embolisms. Prempro was shown to reduce colon cancer and promote bone density. But elevated death rates from heart attacks, stroke, pulmonary embolisms, and breast cancer were so alarming that researchers halted the study three years early, saying it was too dangerous to allow the research subjects to continue taking the drug combination.

The effects of this study were far-reaching. In the year it was published, U.S. pharmacists filled some 45 million prescriptions for Premarin and 22 million for Prempro, and an estimated 38 percent of American women were on synthetic HRT. Tens of millions of menopausal women didn’t know where to turn. Many weighed the risks and remained on synthetic hormones. And doctors continued prescribing the drugs for short-term use, reasoning that the study had focused on long-term effects.

The role of doctors in the hormone-replacement controversy remains unclear. Dr. Susan Love, author of Dr. Susan Love’s Menopause and Hormone Book, is a prominent women’s health specialist and long-time critic of HRT. She charges, “The incestuous relationship between the pharmaceutical companies and the medical establishment is part of it. A lot of information doctors get is channeled through the drug companies.”  The American College of Obstetrics and Gynecology, responding to the study findings, created a task force to rethink its guidelines on HRT. The task force chairman, Dr. Isaac Schiff of Massachusetts General Hospital, declared: “Ten years ago it was almost malpractice not to endorse estrogen. Now the bubble has burst.”

If nothing else, doctors had failed to question the safety of synthetic hormones, ignoring earlier studies that pointed to a problem. It took concerned women in positions of power to push the medical establishment to take up the issue. The Women’s Health Initiative, launched in 1991 by women’s groups and female legislators including outspoken U.S. Rep. Pat Schroeder, took several more years to get research funding. Schroeder, the former Democratic congresswoman from Colorado, fumed that in the late 1970s the largest study conducted by the National Institute on Aging hadn’t included a single woman. “They didn’t know anything about osteoporosis, menopause, anything,” she told Time. “They wouldn’t do anything for women but throw pills at them.”

Change happens slowly in the medical establishment. After the initial alarm over the dangers of HRT, public concern faded with the headlines. It took another study, this time of estrogen alone, to drive the point home. The study was again conducted by the Women’s Health Initiative and again aborted when researchers found that estrogen not only failed to reduce the risk of coronary heart disease, it increased the risk of stroke.

Another wave of women discontinued their therapy. Prescriptions for hormone replacement drugs plummeted during the twelve months following the release of the study. According to the Journal of the American Medical Association, sales of HRT drugs fell 38 percent; sales of Prempro, the popular estrogen-progesterone cocktail that was the subject of the first WHI study, fell 74 percent, as stated in June of 2004 in the New York Times. Research commissioned by drug companies showed that 18.5 million American women were using HRT in 2002, and only 7.6 million by January 2004. Women who continued to take synthetic hormones to treat menopause did so uneasily, feeling they had no alternative. But a large number of women, skeptical of the medical establishment’s sincere concern for their well-being, undertook research on their own. Some of these women eventually end up in my office seeking a more holistic approach to their health.

Meanwhile, the cycle continues. The New York Times article also states that recent studies indicate that the drop in HRT use is bottoming out, and some doctors are seeing increased demand for synthetic hormones. Eager to meet the demand, drug manufacturers are offering lower-dose versions that are widely presumed (though not proven) to be safer. Dr. JoAnn E. Manson, chief of preventive medicine at Harvard University’s Brigham and Women’s Hospital in Boston and a principal investigator for the Women’s Health Initiative, offered this precaution: “Until proven otherwise, we should assume all medications in a similar class have similar risk. It’s biologically plausible that a lower dose might have a lower risk, but we don’t know yet.”5 Given the number of years it takes to complete a well-designed study, millions of women may be jeopardizing their health awaiting the results.

Synthetic Estrogen: The Quick Fix
Just like the women who want a pill to dissolve their menopausal problems, researchers and the drug companies that fund their work ache for a simple solution. That’s why they have focused for so long on estrogen: It has been known for decades that depletion of this hormone plays an essential role in the effects of menopause. It turns out, however, that estrogen imbalances can’t be resolved simply by adding estrogen. The issue is much more complex.

The various sex and stress hormones including estrogen, progesterone, testosterone, cortisol, and DHEA function in relation to one another in a balance known as homeostasis. A drop in estrogen will trigger a rise in cortisol; a rise in cortisol will first raise and then eventually trigger a drop in DHEA, and so on in a process that favors equilibrium. Under conditions of prolonged stress, for example, the body reacts by diverting hormone production from sex hormones to stress hormones. This is a built-in survival mechanism: Under extreme stress, sex hormone production becomes a luxury we can do without.

The quick-fix treatment for menopause ignores this relationship. Researchers chose the most powerful sex hormone and concentrated it into a toxic dose that worked the magic of alleviating menopausal symptoms for many women and filled the coffers of drug companies and their investors. The drug’s long-term consequences were underestimated or ignored. Moreover, the one-size-fits-all approach resulted in highly concentrated doses of Premarin that are eight to ten times what most women need.6 It was easier, after all, for the manufacturers and medical establishment to create a few standard sizes to fit all bodies rather than determine what individual patients need — just as some clothing manufacturers cut corners by offering the ill-fitting approach of small, medium, and large.

There is a fragile balance between the essential female hormones estrogen and progesterone, which are supplemented in hormone replacement therapy. It is virtually impossible to achieve a healthy natural balance for any individual woman using the drugs available. Even if a drug alleviates symptoms, it does nothing to address the imbalance causing them, which eventually will lead to problems systemwide. What appears to us as a malfunction or symptom is usually a response to disruption in the normal production of hormones.

For example, you might be using up progesterone in response to emotional or dietary stress or hidden inflammation, upsetting the estrogen-progesterone balance. Simply adding synthetic progesterone — the conventional solution — may mask the problem but will do nothing to address the underlying issue. The only truly effective treatment is to assess and correct the major sources of stress and the hormonal response to it, using safer, nature-based products in conjunction with lifestyle changes.

Looking to the Future
While the conventional scientific approach has failed menopausal women, it has succeeded in calling attention to its own dangers. Negative publicity surrounding HRT has been a wake-up call leading women to search for alternatives and demand changes from the medical establishment. As a result, more doctors are turning their attention to safer, effective treatments for their patients. And these treatments do exist.

The following chapters will examine an alternative approach, not only to solving a problem, but also to achieving physical, mental, and emotional health. My patients have truly been my teachers and they have made it clear to me that treating symptoms while ignoring their causes is inherently dangerous. I’ll explain how my technique, combining scientific testing and natural treatment, can safely restore imbalances and put women on the track to health.

1. Christine Gorman and Alice Park, “The Truth About Hormones.” Time, July 22, 2002.
2. Geoffrey Cowley and Karen Springen, “The End of the Age of Estrogen.” Newsweek, July 22, 2002.
3. Gorman and Park.
4. Gorman and Park.
5. Leslie Berger, “On Hormone Therapy, the Dust Is Still Settling.” The New York Times, June 6, 2004, section 15, p. 10.
6. Cohen, Jay S. Overdose: The Case Against the Drug Companies: Prescription Drugs, Side Effects and Your Health. New York: Jeremy P. Tarcher / Putnam, 2001.