Do I Need Hormones?

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Many women, bombarded with images of crumpled skeletons and early heart attack, are turning to hormones, "natural" and synthetic, to stave off the ravages of a dreaded enemy.  That "enemy", they are told, is menopause.  We put calcium in orange juice and keep women menstruating into their eighties with hormones, on the assumption that menopause is a disease which must be conquered, and that osteoporosis and heart disease are its inevitable sidekicks.

Yet none of these assumptions is based on solid scientific evidence.  So reasons Susan Love MD, noted researcher on women's health, former breast surgeon, and respected author of Dr. Susan Love's Breast Book and Dr. Susan Love's Hormone Book.  Dr. Love was interviewed in the September 1997 issue of The Journal of Alternative Therapies.

Dr. Love laments what she terms "the medicalization of menopause.  Menopause has gone from being a normal part of life to being a disease that needs to be treated.  Even calling it 'hormone replacement therapy' implies you are replacing something that's missing.  It's supposed to be missing.  We are not supposed to have high levels of hormones our whole lives. ... The newer data show that our ovaries continue to produce hormones, albeit at a lower level. ...It's turning out that menopausal symptoms are the result of hormonal variations, and not from low estrogen at all."  Dr. Love compares the swinging of hormones that occur during menopause to that of puberty, only "it's puberty in reverse. ...And, like puberty, the symptoms are transient - they only last a couple of years."

And what about those dreaded cohorts of menopause - osteoporosis and heart disease?  Dr. Love debunks this association; of far greater concern, she argues, is the clearly demonstrated increased risk of breast cancer from taking hormones.  "The idea that osteoporosis and heart disease are diseases of menopause is crazy.  They are diseases of age.  Estrogen may or may not have a relationship to them, but they are not diseases of menopause.  Heart disease actually doesn't increase in incidence after menopause.  It just continues at the same rate.  And not everybody loses bone in menopause - about a third do, and two thirds don't.  There is a second loss of bone in seventies, which is probably more significant.  The average age at hip fracture is 80.  The average age of the first heart attack is 76.  The average age of breast cancer is 64.  So (by taking hormones) you are trading off: breast cancer at 64 to prevent a fracture at 80. ...If quit smoking, eat a reasonable diet, and exercise, you can prevent 90% of heart disease, with no risk.  ...If you exclude smokers (most early heart disease occurs in smokers), there are three times more deaths from breast cancer than from heart disease."

Some patients ask us about "natural hormones" - specifically, the progesterone cream derived from yams.  Some women, concerned about greater toxicity and side effects from "synthetic" progesterone, are now turning to such creams to balance out estrogen-related effects of menopause, such as bloating and appetite increase - as recommended by Dr. Christiane Northrup, gynecologist and author of Women's Bodies.  Women's Wisdom.  However, Dr. Love does not equate "derived from natural sources" with "natural".  For instance, she asks, is Premarin, which is from pregnant mare's urine, "natural"?  If we use "natural" to mean "more like the hormone your own body makes". "it is not natural for post-menopausal women to have progesterone at all," since progesterone is produced by ovulation (and, of course, menopause is the stopping of ovulation).  "You may find you like the 'natural' ones better than the unnatural ones, but they're all drugs.  None of them is really natural.  The natural thing is to not have drugs after menopause."

So - is there any thing you can, or should, do to make a smoother menopause, prevent the bone loss and heart disease associated in some women with aging, and stay generally healthier?

Dr. Love recommends a diet high in soy and flax seed, based on scientific studies.  These foods have natural estrogenic properties which can make the transition through menopause smoother for some women.  Flax also appears to have cardio-protective properties.  We are all savvy by now about the detrimental effects of saturated fat on cardiovascular health, and newer research is indicating that the "trans"-fat contained in partially-hydrogenated oils is even more damaging (partially hydrogenated oils are contained in especially in margarine, cookies, and crackers - those boxes that boast "NO CHOLESTEROL!").  Weight-bearing exercise has been shown to send more dietary calcium to the bone (making stronger bones), and regular aerobic exercise (jogging on a treadmill, fast walking, biking, etc.) for 30-45 minutes a day is documented to have a host of benefits for the cardiovascular system, as well as improving lung functioning and mood.  And, "just as you want to exercise your body, you want to exercise your brains.  It's very clear that people who are passionate about doing things live longer."  Dr. Love also pints out that studies indicate a positive therapeutic value of support groups, as well as prayer.

Homeopathic medicine has been used successfully for two hundred years to relieve the discomforts of menopause, such as hot flushes and mood swings, with no risk, and virtually no toxicity.  While no clinical studies have yet been devised to prove preventive effects of classical homeopathy on the diseases associated with aging, generations of homeopaths and satisfied clients have observed that homeopathy engenders a state of optimal functioning of body and mind, and so is probably one of the best preventatives going.

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