1985 – The US Nurse’s Health Study involving 120,000 women found that oestrogen replacement in post-menopausal women reduced the risk of heart disease.
1995 – The US Nurse’s Health Study found that oestrogen increased the risk of breast cancer.
1997 – The Collaborative Group on Hormonal Factors in Breast Cancer found that women on HRT have a three times higher risk of blood clots.
2000 – The National Cancer Institute study found a 40 per cent increase in the risk of breast cancer in women on combined HRT.
2002 – The US Women’s Health Initiative (WHI) Study showed that combined oral HRT increased the risk of blood clots, stroke, cardiovascular disease and breast cancer.
In the 1970s we found that oestrogen given alone increased the risk of uterine cancer, so we then added synthetic progestogens to the oestrogen, to stop this danger. However, in avoiding HRT-induced uterine cancer, we then induced even more dangers – namely an increased risk of breast cancer, cardiovascular disease and blood clots. In other words, by trying to prevent one type of cancer, we have introduced a range of different, unexpected problems. The results of the WHI Study show definitively that when synthetic HRT interferes with the balance of the body’s natural hormones, we can expect adverse effects in a significant number of women.
Oral Combined HRT – No Longer the Gold Standard
Oral combined HRT generally consists of tablets containing natural or equine oestrogens, combined with a synthetic progestogen.
The vast majority of the long-term studies of HRT have been done using hormone tablets, most of them using equine-derived oestrogens and synthetic progestogens. These studies have not examined the long-term risks of natural hormones that are absorbed through the skin, such as gels, creams and patches. Absorption of hormones through the skin is called transdermal absorption, as opposed to oral absorption.
Hormones applied to the skin do not pass through the liver immediately after absorption. There is a huge difference in the metabolic effects of oral hormones compared to hormones that are absorbed through the skin (transdermally).
One of the major reasons that large long-term studies on natural HRT absorbed through the skin have not been done by drug companies is that it is not possible to patent a truly natural hormone. Thus there is no financial incentive for drug companies to do these very expensive studies, as they would never recoup their costs.
Personally I have never felt comfortable prescribing hormone tablets for the long-term treatment of menopausal symptoms. This is because hormone tablets must be broken down by the liver immediately after their absorption from the gut, and thus will exert metabolic changes in the liver. These metabolic changes can increase the production of proteins, including clotting factor proteins by the liver, and this is why HRT given orally will increase the risk of blood clots.
I have also found that oral HRT will cause weight-gain in many women, and that is because it increases the workload of the liver. The healthy liver is the major fat-burning organ in the body; if you increase its workload, there will be less metabolic energy left within the liver cells to burn fat.
Oral combined HRT can increase the incidence of migraines, high blood pressure, high cholesterol, fluid retention and liver and gall bladder problems, once again because of its adverse effect upon liver function.
How It All Started
Many women are now feeling confused, and no doubt somewhat abandoned, as they learn of new controversies about the hormone tablets they take, which drug companies once promised could protect their bones and hearts from the ravages of time.
Well, let’s face it, hormone replacement therapy is nothing new, and has always been controversial, and either in or out of fashion.
Way back in 1889, Professor Charles Edouard Brown-Sequard announced to the French Academy of Sciences that he had injected himself with testicle juice extracted from the pulverized testicles of guinea pigs. He proudly stated that this testicle juice produced a miraculous rejuvenation in his body! At the time of injecting himself he was 72 years old, and his state of physical exhaustion had led him to experiment with a hormonal treatment. He said that, ‘Before I gave myself these injections, I could not work for more than half an hour in the laboratory without having to sit down; even when I was sitting down I felt exhausted after three hours of work. By the third day after starting these injections, all that was changed, and I had recovered my former vigour. I can now without effort or even thinking about it, run up and down the stairs – as I used to do, up to my 60th birthday. After the first two injections, my forearm showed an increase of 6 or 7 kilograms over its previous strength.’
Professor Brown-Sequard was talking about the powerful rejuvenating effect of the hormone testosterone, which was present in abundant amounts in the guinea pigs’ testicles. He also obtained excellent results after injecting ovary juice into women. The Medical Record of 20 June 1889 acknowledged that Brown-Sequard’s discovery was brilliant, if incomplete. Although he was controversial, in many ways he advanced the speciality of hormones, known as endocrinology, and he was a great researcher.
Progesterone was isolated and collected from the ovaries of pigs, and from human placentas, in the early 1930s. In 1938 natural progesterone was first synthesized from the plant hormone diosgenin, by an American biochemist named Russell Marker.
In the 1940s natural forms of HRT were developed mainly by Schering Pharmaceuticals in Germany, and injections containing natural oestrogen, progesterone and testosterone became popular.
Oestrogen therapy first became famous in 1966, when American doctor Dr Robert Wilson, released his best-selling book Feminine Forever, which promoted oestrogen as the elixir of youth. To Dr Wilson, his discovery that oestrogen was able to rejuvenate women’s lives was just as momentous as the replacement of insulin in people with diabetes, who could no longer make insulin themselves. In The Journal of the American Geriatric Society in 1972, Dr Wilson wrote, ‘Breasts and genital organs will not shrivel, and women will be much more pleasant to live with, and will not become dull and unattractive.’ I do not think that Dr Wilson’s comments would be popular with modern-day women – they are decidedly sexist and ageist!
Professor Brown-Sequard and Dr Wilson were correct – hormones are powerful rejuvenators with anti-ageing effects, and many people have had their lives dramatically improved by the use of natural HRT.
Changing Attitudes
Compared to 100 years ago, women now have a much longer life span, and go through the menopause at a relatively young age. This begs the question – ‘Is it really natural to load up every post-menopausal woman’s body with high doses of synthetic hormones for the last 20 to 30 years of her life, just to prevent chronic diseases that may never happen?’
I think to do so is an over-reaction to a normal phase of a woman’s life. You could say this approach is not natural nor physiological, and yet during the past 20 years we have come to see this practice as acceptable and even desirable. I think this idea originated in the mid-1980s when the ‘medicalization of the menopause’ was first promoted. This concept generated fear that women must do something drastic to overcome the ‘disease of the menopause’. In 1985, a special supplement in The Medical Journal of Australia stated that, ‘The post-menopausal climacteric should be regarded as a sex-linked, female dominant, endocrine deficiency disease, with specific symptoms and signs, which should be investigated and managed in a very careful and considered fashion, for the remainder of the woman’s life.’ This concept was promoted to the medical profession, so that doctors started to see the menopause as a disease state, for which they should prescribe therapy. Thus the idea of the menopause as a disease to be feared was passed on to women by their doctors and the media. Women’s attitude towards their own menopause started to change, so that they no longer saw it as a natural phase of their lives. This imposed attitude was a barrier to women seeking to get in touch with their own feelings and reactions towards the menopause. They started to see hot flushes as a symptom of disease, and the term ‘the change’ became