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:
E1/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.
E2/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.
E3/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 Therapy (HRT):
- 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 homones (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 needed here.
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 term HRT.
RISK FACTORS FOR OSTEOPOROSIS:
- family history of osteoporosis or hip fractures
- ovaries removed especially before age 40
- no full-term preganancies
- 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 electro-magnetic 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 ingestsufficient protein and avoid phosphates (soda pop – use fresh juices instead). Barbitruates and steroids (such as Prednisone) inhibit calcium and Vitamin D absorbtion. Herbal bone protectors include Red Clover flowers, Marshmallow root, and Horsetail reeds.
Heart disease is another complex topic, inlcuding 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, DC 20005.