Hormone Replacment Therapy has been promoted in such a way that both the public and the medical profession assume that it is a necessary treatment course for any woman going through the menopause. However, much research since the 1960s leads to the conclusion that the use of hormones creates dangers that outweigh the claimed advantages.
The orthodox world would unhesitatingly encourage the use of hormone replacement therapy but initially alternative treatments can alleviate the problems without entailing the potential risks and side effects of HRT.
Osteoporosis and cardiovascular disease are not the inevitable outcome of passing through the menopause, and protection against these conditions is discussed here.
Along with vaccinations, the promotion of HRT is, in my opinion, one of the most devastating and misleading of the orthodox medical world’s health guidelines. The medical profession seems to consider the menopause to be a ‘deficiency disease’. It compares the lack of female hormones to that of thyroid or insulin deficiencies, which is simply not true. Four-fifths of the world’s population will not have access to artificial HRT. It is ironic that this so-called ‘third world’ population also have strikingly lower levels of osteoporosis, heart disease, cancer and menopausal symptoms, which HRT is supposed to protect against.
Japan and Africa have negligible amounts of osteoporosis, cardiovascular disease and stroke in comparison with the West due to healthier lifestyles, nutrition and more exercise. All of these are very relevant to the disease processes that HRT supposedly helps to prevent.
Frankly and factually, the processes of ageing that the Western orthodox medical world would have us believe are due to our lack of oestrogen and progesterone are simply not reflected in those societies that have not been targeted for HRT use. Most, if not all, of the serious conditions and a majority of unpleasant symptoms are created by factors other than female hormone depletion. Nutrition, life-style and exercise are far more relevant than hormone levels.
Hormone replacement therapy is not well proven either in safety or efficacy. The pharmaceutical industry and many Gps may be unaware of scientific studies published in reputable medical journals that state that HRT has risks and is not as effective as we have thought.
Initially HRT was brought forward to remove the unwanted symptoms that the Western woman found uncomfortable. That is not to say that women from less-developed countries do not suffer similarly, but here in the West we are brought up to believe that any symptom is unnecessary and should be removed, regardless of the reason why it may be there. Most uncomfortable sensations are either a warning or a repair process and if the underlying cause is diagnosed and treated, the symptom often goes away. Unfortunately, after a few years it was found that 50% of women who used HRT to alleviate menopausal symptoms stopped using the preparations because of unwanted side effects or ineffectiveness of the treatment. The pharmaceutical companies experimented with different levels of various oestrogens and progesterones and claimed that the newer preparations were far more effective. My experience and that of my senior colleagues supports latter-day studies showing that many women are still struggling with side effects, including continued periods.
The next stage was the pronouncement that HRT prevented osteoporosis. Many widely promoted studies showed that the use of artificial oestrogen prevented bone loss. Unfortunately for the HRT supporters, a large study of women in Framingham, Massachusetts is proving that shorter studies are not accurate and in fact are flawed. Only women who have been taking HRT for more than seven years show any appreciable difference in bone density and, because these women are at far greater risk of developing oestrogen-dependent cancers, the risk of more serious conditions outweighs any benefits. What is more, if women stopped their treatment after ten years, they would have the same fracture risk as the population who had not used HRT. Because most women may be advised to use HRT at around the age of 50 years and most hip fractures tend not to occur until the mid-seventies in age, one can immediately see the pointlessness of using HRT for this condition.
The industry went on to ‘prove’ that the use of HRT protects against coronary heart disease, stroke and raised cholesterol levels. I am afraid not. The Framingham study mentioned above suggests that the risk of heart disease is actually increased and contradicts the findings of numerous studies.
Up until 1993 the main studies supporting HRT as a protection against vascular disease were found to be markedly flawed. An example of this in one of the major trials is described in medical circles as ‘selection bias’. A large group of women were divided into those who would receive HRT and those who would receive a placebo. Neither group would know what they were taking. For ‘ethical’ reasons all women in the group taking HRT who had any risk factors, ie health problems or genetic predispositions to diseases that were associated with oestrogen or progesterone, were eliminated but this same factor was not taken into consideration in the control group. What this meant was that those taking HRT were already at a much lower risk for cardiovascular disease than the control group. When the results came forward they were, not surprisingly, markedly in favour of HRT being a protector of women from heart attacks and strokes. The debate continues but I have yet to see any new trials that are supportive of HRT in these conditions. In fact, a recent British Medical Journal article showed no significant benefit from HRT in cardiovascular disease over a 10-year period.
The latest suggestion is that HRT may protect against certain bowel conditions but I think even the pharmaceutical industry is aware of this being a weak selling-point.
The risks of HRT
The availability and promotion of HRT has led to the GP neglecting or avoiding the necessary discussion about changes in our diet and the exercise we take, as well as the potentially damaging effects of smoking, alcohol and drugs. Menopause has become a trigger for Gps to prescribe either oestrogen-only preparations or the oestrogen/ progesterone combinations.
To understand the risks it helps to know what the sex hormones are doing. Principally, oestrogen and progesterone stimulate cell division, especially in the inner lining of the uterus, breast tissue and ovaries. This is achieved by increasing the blood supply to these tissues by improving the strength of blood vessels and opening them up. These are exactly the reasons why people develop headaches, migraines and cramps.
The hormones also increase the clotting ability in the blood by making platelets adhere more. readily and they also detrimentally raise fat levels in the blood. This combination in the slower blood flow in dilated arteries leads to blood clots, heart attacks and strokes.
Putting aside the ineffectiveness of artificial HRT, there are also the frank risks of taking these artificial chemicals. Despite discussions with gynaecologists and scientific specialists in this area, I am still very confused by what appears to me to be a simple logical argument. In the British National Formulary, the official publication of the Royal Pharmaceutical Society of Great Britain that lists all the drugs available, there are 27 contraindications and 17 side effects of the use of the oral contraceptive pill. Hormone replacement therapy, made from predominantly the same chemicals, only lists seven contraindications but practically similar side effects. For some reason, when women reach the age when HRT can be prescribed, all the side effects that they may have had from the contraceptive pill a year previously are no longer a risk. Doctors, and I include myself in this, are actually told, for example, that the oral contraceptive pill should not be used in ladies with high blood pressure before menopause but at menopause this combination of artificial hormones may actually benefit hypertensives because of the protective’ effects against heart attack and stroke. It does not make sense. I frankly find it indefensible and cannot understand why our professors persist in refusing to see the wood for the trees.
As well as the inefficiency and lack of efficacy of HRT, there are actually proven risks that each individual must take into account before embarking on a course of treatment.
Uterine cancer was found to be seven times greater in women using HRT. This was at a time when oestrogen was being used without progesterone to oppose’ it. The orthodox medical world rapidly announced that the use of progesterone negated these results but they failed to mention the continued risk of uterine cancer, which was still three times greater despite the use of progesterone.
Breast cancer is also increased by the use of HRT. Studies suggesting protection by HRT are promoted by the pharmaceutical companies, contrary to the evidence of large studies showing that combination HRT increases the risk of breast cancer to four times that of non-HRT-using women if it is taken for over six years.
Certain trials have shown that oestrogens and progestogen increase other cancers, such as cancer of the ovaries, cervix, pituitary gland, liver and the skin .
The reason why these are not well documented is because money is not available to put into trials that repeat negative results.
Thrombosis , strokes and heart disease
Every doctor will advise a woman that the contraceptive pill can cause blood clots, most commonly deep vein thrombosis in the legs. Any past history or family history of blood clots, high blood pressure or obesity, history of strokes or other cardiovascular problems all contraindicate the use of oral contraceptive pills . If the OCP is known to cause problems, there is no reason to believe that because a woman ages the chemicals will alter their functions.
One of the main hypotheses supporting HRT against heart and vascular disease is the effects of HRT on reducing cholesterol. The trials, according to eminent research scientists, have all been flawed and based on the assumption that lowering cholesterol levels will alter rates of cardiovascular disease in post-menopausal women. None of this has been conclusively proven. What is more worrying is the continued promotion of these unsubstantiated studies despite the evidence of large follow-up studies showing that HRT is not effective in reducing cardiovascular problems and in fact may increase risks.
Other side effects
Specific problems such as skin conditions, jaundice, vomiting, stitches and physiological disturbances such as depression and irritability can all be caused by HRT. One study in the UK showed that there was an increase in suicide in groups using HRT. What is more distressing is that symptoms of menopause may be worsened or initiated by HRT. I occasionally see patients who have unique symptoms such as muscular aches and pains, abdominal spasms and neurological symptoms such as dizziness and pins and needles. I cannot categorically state that these have been caused by HRT but the symptoms improve when the treatment stops.
There has been reported in one study a six-fold increase in asthma in women who use HRT.
Natural oestrogens and progesterones
There is a bandwagon rolling to support natural female hormones. These are plant derivatives that actually contain exactly the same types of sex hormones as the human body, as opposed to the artificial chemicals in HRT that only resemble ours. Natural oestrogens from plants, known as phyto-oestrogens, are much less potent than artificial hormones but the body seems to respond to them if their application is appropriate. These oestrogens are obtained from hops, fennel, celery, soya products and rhubarb, all of which can be fed comfortably into the diet. Extracts from specific plants can be obtained from healthfood shops as ‘food products’ because no medical claim can be made. It is interesting to note that Japanese women who have a much higher level of soya products in their diet have negligible levels of osteoporosis or heart disease.
Natural progesterone has risen in popularity on the back of the work of a doctor called John Lee in the USA. Dr Lee was unimpressed by the efficiency and effects of oestrogen and looked toward decreased progesterone as a possible cause of menopausal problems. His research and personal experience suggested, and has since shown, that a bulk of symptoms that women complain of and the diseases such as osteoporosis that are associated with ageing may be due to the lack of progesterone and not oestrogen. There is much evidence to support this. As the pharmaceutical industry cannot patent a natural compound there is no point in experimenting or studying natural progesterone and so most of Dr Lee’s work has not been repeated.
Natural progesterone has been extracted from the Mexican yam and needs to be administered transder-mally because, like any complex chain, it is unlikely to survive the digestive system intact. Natural progesterone does not seem to have an effect on the hot flushes and sweats that are the main disturbing feature for most women going through the menopause, but it may have an effect on all the other symptoms. Most encouragingly, it has a profound effect on osteoporosis .
Oestrogen-dependent tumours, most commonly found in the breast, may benefit from these phyto-oestrogens. A study in a top London hospital is currently ongoing and it would appear that these plant oestrogens may lock into oestrogen receptors, thereby preventing the stronger body hormones from exerting an effect. There may be some risk that the plant extracts will actually encourage oestrogen-sensitive tumours, but the experiments to date are encouraging. It may be that premenopausal women should use phyto-oestrogens and natural progesterones as protection factors in any oestrogen-related condition.
Types of HRT
The oestrogens are taken as a tablet, patch, an implant or a gel. Any woman who still has her uterus must take regular progestogen , which is usually taken as a tablet. The progestogen blocks the oestrogen effect. Usually the progestogen is taken for 12 days but many women suffer the progesterone side effects, which are principally fluid retention, headaches, skin reaction such as acne and other pre-menstrual syndrome symptoms. Women who have gone through the menopause and have not had a period for at least 12 months are offered the combined preparation, which is taken continuously. These do not cause periods to occur, which is certainly a favourable option. Another option is to take an oestrogen preparation and progesterone, say, four times a year, giving a bleed every three months. This is offered to those women going through menopause who may still be having infrequent periods. I mention this for information and not as a support of their use. In fact, my views are quite the opposite.
Dosage of HRT
Hormone replacement therapy is mostly given orally or via skin patches. These may be combination pills or oestrogen with short courses of progesterone to encourage a period or offer ‘protection’ from the unopposed oestrogen. Implants are becoming more popular but their safety is highly questionable. For a start the ovaries, adrenal glands and fat stores can all produce hormones at fluctuating rates years after the menopause. An implant delivers a set dose regardless of the amount that is made by the body naturally. This can cause overdoses, which will lead to all the risks and side effects listed above.
Avoid your doctors advice, who will be encouraging the use of HRT.
Work with a complementary medical practitioner if the signs and symptoms of menopause are disturbing.
Obtain relevant blood tests to establish menopausal status.
Consider urinary protein tests and ultrasound bone densitrometry to establish a baseline for osteoporosis.
See Arteriosclerosis with regard to the better dietetic regimes and supplemental treatments to protect against cardiovascular disease.
If you are currently using or considering the use of HRT, consult a complementary medical practitioner with experience in this area.
See Osteoporosis, Stroke and Heart attack to establish the alternatives to help protect against these conditions in latter years. These techniques are as useful as any positive aspects of HRT.
Consider the use of natural hormone creams, available through specialist complementary practitioners and all doctors if they are willing to read the information and prescribe it