All women were put into the same ‘herd mentality’, and the concept of treating all menopausal women the same was created; in other words, ‘one-brand one-dose of HRT’ was thought to fit all women. The concept of ‘super-market-brand-name-HRT’ became entrenched, and the last 30 years of a woman’s life was now a lucrative commodity.
I was never impressed with this concept, as I could see that many of my patients were unsuited to oral synthetic hormones. My suspicions about oral HRT were confirmed when, as a young doctor in the 1970s, I visited the retirement haven of Miami Beach in the US. During the 1970s, the Premarin brand of oestrogen was the fifth-biggest-selling prescription drug in the US. In Miami Beach I observed thousands of older women enjoying their golden years who had been, or were taking, the fashionable HRT. However, these women did not look healthy – their skins were wrinkled and their postures stooped, and they lacked vitality. Unfortunately the elixir of synthetic hormones could not undo the damage from years of inactivity, smoking and consuming refined processed foods. Interestingly, during the 1980s when I worked in a missionary hospital in northern India, the older women looked much stronger and more youthful than those in Miami Beach, despite a life of hard work, no HRT and nutritional restrictions.
During the 1990s, HRT continued to increase in popularity, and in the year 2000, 46 million prescriptions were written for Premarin (equine oestrogens), making it the second most frequently prescribed medication in the United States, accounting for more than $1 billion in sales, and 22.3 million prescriptions were written for Prempro (Premarin plus Provera). The US Food and Drug Administration approved this type of HRT for the relief of menopausal symptoms and the prevention of osteoporosis, and long-term use of HRT became fashionable to prevent a range of chronic diseases, especially heart disease.
Women Want Choices
All of the millions of women out there who have been happily taking oral combined HRT now find themselves in a dilemma. Many feel they have been misled or abandoned, however the current situation is a reflection of the fact that research takes many years to give us long-term results. Well, we do not want to be research guinea pigs! Now is the time for women to stick together and explore the safest and most natural options. Yes, it is a time where common sense and instincts should prevail, and luckily you do not have to be a rocket scientist to see that there is a world of difference between the different types of HRT now available. Indeed, you do not even have to be a doctor!
This book will take away the fear and confusion surrounding HRT and the menopause, and bring you right up to date. There is no doubt that certain types of HRT can help to slow down the ageing process and improve the quality of your physical, mental and sexual life.
There is no need to give up all hope; some forms of HRT may be able to help you, with minimal risk involved. In other words, you don’t have to throw the baby out with the bath water!
Very few things in life are risk free or come with a 100 per cent guarantee, so let’s get real! We all take a calculated risk every time we drive a car, play sports or, indeed, leave the house. You can even get robbed while you are still at home, and you can never indemnify your life completely. Most of us want to live life to the full and feel challenged, stimulated and sensual, so we take calculated risks every day.
If we can relieve the unpleasant symptoms of the menopause and ageing with effective treatments that do not expose us to unacceptable risks, then we have achieved the best possible compromise. By understanding the ways that natural HRT can be given without upsetting the body’s natural equilibrium, we increase our choices of strategies that will safely improve the quality of our lives.
Some women will not need any HRT, and will need instead a good diet and healthy lifestyle. Other women will find that the menopause and ageing process produce undesirable and/or painful changes in their body and mind, which can only be relieved with some form of natural HRT.
Thankfully, the menopause is no longer ‘the change of life’ that is to be feared. I often reflect upon just how difficult it must have been for women who lived in the early 1900s to cope with these unpleasant symptoms. They must have been very strong women indeed, but strength alone cannot get you through severe hot flushes, insomnia, a desolate sex life, fibromyalgia or a severe emotional imbalance. These women had no choices – no HRT, no anti-depressant medications and probably very little understanding from society, the medical profession or their families.
Today, women have vastly different expectations of life, and do not want to suffer unnecessarily with unpleasant symptoms. They do not want osteoporosis, rapid ageing or an unsatisfying sex life.
Since the 1940s, HRT has gone through many trends, fashions and different types of packaging. We now have so many ways of putting hormones into your body that it is quite incredible! This ranges from hormone tablets, implants, injections, pessaries, vaginal rings, patches, creams, gels, sprays and lozenges (troches). Among all these possible ways of taking HRT, it is now possible to find a safe tailor-made programme of HRT to suit every woman who wants to take HRT.
Thankfully, the woman of today has access to natural HRT, modern-day drugs and nutritional medicines that can alleviate the symptoms that were once considered the hallmark of the beginning of ageing. Yes, we are truly fortunate to be living in this day and age!
The Modern-day Controversy about Hormones
Before the results of the Women’s Health Initiative (WHI) Study were published in August 2002, millions of women in the UK, US and Australia were using some type of HRT.
The use of non-hormonal alternatives for the menopause has also increased. It is true that drug companies have a vested interest in the lucrative baby-boomer generation of women, and it is true that women also have a big interest in a type of HRT that will promise them a better quality of life. However, the baby-boomer generation of women is well educated and discerning, and wants to know the real facts.
Thus, the results of the WHI Study on the effects of combined oral HRT on 16,000-plus women was very timely, and have proven to be a defining moment in medical history that could be considered a bombshell for many researchers in the field of HRT.
The Study uncovered some alarming findings that obviously worry doctors and consumers of HRT. The data and safety monitoring board recommended stopping this trial prematurely because women receiving the active hormones had an increased risk of invasive breast cancer, and an overall measure suggested that the HRT was causing more harm than good. The decision to abandon the trial occurred after an average follow-up period of 5.2 years, although the trial was originally planned to continue for 8.5 years. There were other outcomes that suggested danger, such as an increased risk of coronary heart disease and pulmonary embolism.
Overall, the results of the WHI Study confirmed the growing body of evidence that combination oestrogen/progestin tablets can increase the risk of breast cancer with increasing duration of use, and increase the risk of stroke and blood clots during five years of use. The increased risk of coronary heart disease was largely found during the first year of HRT use. Overall, this American study found that women on combined oestrogen and progestin tablets had a 26 per cent increased relative risk of developing breast cancer, a 29 per cent increase in heart disease, and were 41 per cent more likely to have a stroke. Most of these problems began appearing within the first one to two years of HRT use, but the increased breast cancer risk did not begin until three years of use.
Positive effects of the combined HRT regime were a reduction in the risk of bowel cancer and bone fractures.
In terms of absolute risk, the above figures can be translated into the following statistics – if 10,000 women take combination oral HRT for one year, eight more will get invasive breast cancer, seven more will have heart attacks, eight more will have strokes, and eight more will have blood clots,