From the very day it enters a woman’s mind that replacing hormones is something she should think about, she will immediately enter a zone of conflicting information and loose facts and prejudices from the media, her friends, her internist, her gynecologist, or her mother, all mixing together with her own preexisting ideas into a confusing stew. So before we can even begin to discuss our plan, we need to clear away some misunderstandings and misinformation.
“Taking estrogen is dangerous.” How many women have you heard say this? If we could single out the most damaging consequence of the controversy over HRT, it would be that estrogen–this essential life-enhancing friend to your body–has become for many women a dirty word.
What Is “Estrogen”?
Since the first hormone replacement drugs were put on the market over fifty years ago, it has become an ingrained practice to use the word “estrogen” indiscriminately for both the estrogen your body produces and a wide range of diverse hormonal preparations. Drug companies with hormone replacement products have contributed significantly to the confusion by continually referring to their products as simply “estrogen.”
A woman will tell a friend that she is taking estrogen, thinking she is ingesting a single substance called estrogen that conforms to the hormone produced in her own body. But estrogen is, in fact, not a single hormone but a family of hormones, consisting principally of estrone (E1), estradiol (E2), and estriol (E3). Along with these three principal estrogens, we know that there are at least two dozen(1) identified estrogens produced in a woman’s body, and researchers may well discover others. Premarin contains 48 percent estrone (natural to humans) and 52 percent horse estrogens (natural to horses). It also contains additives that are foreign to a woman’s body. None of the American drug products contain estriol (E3), which has been used widely in Europe for over fifty years, and which new studies have shown to be cancer preventive.(2) Estriol, the estrogen most dominant during pregnancy, has particular benefit for women who are at risk for breast cancer and need hormone balancing and replenishment. In Europe, it is particularly favored for use in vaginal preparations, such as Oevestin. The reasons for its being completely ignored in the United States until recently will be discussed at greater length in chapter 6.
Most media reporting contributes to the confusion over “estrogen” by failing to make clear which estrogen they are referring to or to make distinctions as to what specific products are being discussed or tested. None of the mainstream media articles reporting the recent studies of increased incidence of breast cancer in women on HRT mentioned the fact that the subjects had used Premarin. Of the three principal estrogens circulating in a woman’s body, the one predominantly implicated in increased cancer risk is estradiol. Premarin, as noted, is formulated with estrone, which converts to estradiol. Estriol, as we have just mentioned, has cancer-preventive properties. So when the results of studies are announced that show increased risk of breast cancer in those women on HRT, it is unfortunately estrogen that is
demonized and not the specific products tested.
The fact is, you cannot live without estrogen. Estrogen is not merely a “sex” hormone, as there are presently three hundred known functions for estrogen in the body and we are only beginning to understand all its interactions. Every cell in your body has receptors–what you might think of as little landing docks–that receive the complex hormonal messages circulating through your blood. There are estrogen receptors in all your vital organs–such as your brain, your heart, and your liver–and all through your body. Estrogen spurs the production of an important enzyme in the brain that helps the connections between brain cells to flourish. It is estrogen that helps maintain verbal learning and enhances a woman’s capacity for new learning.(3) Indeed, estrogen supports you from birth until death.
Ironically, most of the studies relating to HRT products have gone very far to show what an important role your own naturally produced estrogen plays in the functioning of your body. But in its rush to give women the benefits of estrogen, the medical/pharmaceutical establishment has simply continued to promote the standard hormone products now available from the major drug companies without looking for better and safer alternatives that also don’t have the negative side effects of the standard drugs.
Does “Estrogen” Cause Cancer?
Almost all the studies that link estrogen to an increased risk of cancer have been related to taking Premarin or other common drug products. Premarin is extracted from horse urine. While it contains helpful estrogens like estrone and estradiol, it also contains equilin and equilenin (horse estrogens) and synthetic additives. It is the taking of unbalanced and foreign estrogenic elements and additives that we believe is dangerous and potentially cancer producing, not estrogen itself. When used appropriately, the estrogen from natural plant sources, which matches your own hormones exactly, does not produce harmful side effects.
Standard medical practice prescribes drugs using the so-called risk/benefit factor. The side effects of a drug are medically accepted hazards of treatment: The judgment is made that the benefits outweigh the risks, and doctors are willing to accept the fact that you may suffer serious consequences. But are you willing to accept it?
A major link between raised estrogen levels and breast cancer is primarily a ratio problem–the ratio between estrogen and progesterone in your body, which can be brought on by poor diet, poor digestion, lifestyle habits, stress, or environmental factors. In the simplest terms, unbalanced estrogen-to-progesterone levels can cause a relative or absolute “estrogen dominance,” which can lead to the proliferation of cancer cells. When the first hormone replacement drugs were put on the market, the symptoms of menopause were understood primarily in terms of “estrogen deficiency,” but this has since proved to be a narrow vision. This erroneous medical model takes one hormone, estrogen, out of context in the body’s functioning, and neglects the importance of progesterone. Just by correcting diet and digestion, you can decrease your environmental exposure and improve your body’s ability to balance estrogen and progesterone and eliminate estrogen dominance. A plant-rich diet helps eliminate estrogen dominance and is actively anticarcinogenic.
But I Love My Premarin
On the other side of the aisle from those women who have an undifferentiated fear of estrogen are those women who simply continue to take Premarin or Premarin/Provera or the other commonly prescribed HRT drugs and shut their ears to all controversy.
Let us say right up front that we are not against “hormone replacement” per se, although what we are advocating could more accurately be called hormone balancing or replenishment. When it comes to dealing with temporary symptoms, such as hot flashes, night sweats, and vaginal dryness, Premarin has been shown to be effective. But we do think it is a crude product–crude in the sense that it was developed during the early stages of hormone investigation and contains estrogens foreign to a woman’s body. We think this lack of conformity to a woman’s body is what contributes to its side effects.
Those women who are able to tolerate Premarin can go on taking it for years–well past the five-year mark that most studies consider a critical period–all the while harboring the worry that if they go off it, the chassis will start to break down and various parts will begin to fail or fall off. These women face a difficult dilemma: If the drug they are using seems to be working, it’s hard to consider a change. But ignoring the potential for harm can be dangerous to your health.
To add another complication, Premarin and its sister drugs are now being advertised as necessary to ward off osteoporosis and heart disease, opening up a whole new marketing strategy to sell these drugs to you for long-term use. When they were first put on the market, the primary emphasis was on short-term treatment of temporary symptoms, but by advocating use of these drugs for long-term use as prevention against heart disease and osteoporosis, a whole new element of danger and confusion has been added.
The Profit Motive
Why haven’t the makers of standard HRT drugs sought out safer alternatives? In the case of Premarin, 940 million dollars and growing is the answer. Premarin is the number-one best-selling drug in the country.(4) Why haven’t American pharmaceutical companies strongly marketed these safer bio-identical plant-derived hormone products? Simple. They can’t be patented, which means that no single company can corner the market. And since research money will flow only to those projects that will provide a drug company with so-called protected profit, “natural” will always lose to “synthetic” in the pharmaceutical world.
Since the late 1800s, U.S. law has allowed medicines to be patented only if they are not natural substances. If, for example, a pharmaceutical company decides to market a natural substance, another competing company could ride on its coattails and dilute its profitability, hence the notion of creating drugs with protected profit. Many natural substances are changed into patentable drugs simply by changing a few molecules of the natural substance. The decision to do this is often not driven by the desire for a better drug, but rather for one that is different enough to obtain a patent.
But what seems a tiny change in the molecular structure of a substance can make a huge difference in its effect on your body. Adding or subtracting a few hydrogen atoms and a few double bonds in the biochemical structure of estrogen or testosterone is the difference between a male and a female! In the case of Provera, which is a molecularly altered version of natural progesterone, side effects can result because the body doesn’t recognize the substance as completely biologically identical to one in your body.
Fortunately, switching to the plant-derived bio-identical hormones can be done with relative ease. A woman taking Premarin can have an equivalent dose worked out for her by a pharmacist, and she can immediately start taking the plant-derived hormones.
How “Estrogen” Got Politicized
Unfortunately, and for many of the wrong reasons, not supplementing estrogen has become a political cause for some women.
Betty Friedan has taken a strong position against women using HRT. She is also quoted as saying, “I may have had a hot flash, one hot flash, while I was giving a major speech in the middle of the seventies,”(5) implying that women who took anything for menopause were sissies, and dismissing the significance of the menopausal passage altogether.
Well, Friedan is one lucky woman if she only had one hot flash she can barely remember. It probably means she has naturally favorable hormone levels either because of good genetics or her diet, and she is apparently among the 25 percent of women who sail through menopause without symptoms.
But what about the other 75 percent? These women are not as fortunate. Whether because of a complete hysterectomy, or just having their ovaries removed, less favorable genetics, a poor diet, or high stress levels–just to mention a few of the possibilities–these women can become noticeably and often severely symptomatic.
One third of women in this country have had hysterectomies (a shocking number, which we will talk about in a later chapter), and all of these women have suffered a hormonal “disruption” of some magnitude and will need help in balancing.
The impulse to shield women from drugs that are potentially harmful is a good one, but unfortunately, estrogen itself has become demonized rather than the specific products that have been shown to pose risks for a woman’s health.
The negative result is that women who would benefit greatly from the right kind of hormone replenishment or from a treatment plan that would help them deal with uncomfortable symptoms during menopause don’t reach out and get the help they deserve.
Turning a Blind Eye to Menopause
Some women choose to deny the existence of menopause altogether, as if acknowledging it would be admitting that there is a difference between men and women. And some women have even gone so far as to insist that the studying of masculine and feminine differences is subversive to the feminist cause.
From a medical point of view, denying the difference between the sexes can actually have very serious negative consequences and can compound an existing problem. If, as we’ve said, medical treatment in the United States today is fundamentally based on a male body, then from a diagnostic point of view women are already treated like men–but very unequal men. The problems that are unique to women–in this case, hormonal fluctuations and imbalances–have historically been ignored or have been treated as emotional problems. In fact, the word “hysterical” comes from the Greek word for uterus. In the nineteenth century, the typical English doctor would simply remove the uterus when a woman displayed what to his mind was excessive emotionality. The medical literature is dismayingly rife with such examples. To deny the physical uniqueness of a woman is to collude with the prejudice that women have irritatingly aberrant male bodies.
The debate about hormones is being carried on in the wrong arena. The question is not if you should take hormone replacement therapy drugs, but what constitutes a healthy and vital body at menopause and what specific actions and products you should use to manage symptoms and restore balance to support your hormonal system.
What Is “Unnatural”?
Some women decide that they will just let menopause run its course, because taking supplements for it isn’t natural. But the fact is that contemporary life for women has become very unnatural. Over hundreds of thousands of years of evolution, humans have developed sustaining behaviors for their strength and longevity, such as eating a plant-rich diet and moving their muscles regularly. But in the short span of perhaps fifty years, processed foods and preservatives and a more and more sedentary lifestyle have virtually eliminated many of these body-sustaining behaviors from our lives.
It’s not natural to eat processed food.
It’s not natural to eat anything synthetic that doesn’t exist in nature.
It’s not natural to forego the important foods that can help balance your hormones.
It’s not natural to go without physical exercise.
It’s not natural to live in a polluted environment.
Almost all this “unnaturalness” is imposed from without–from the polluted environment, the stress of maintaining two-income households, eating processed food for convenience, or getting less exercise due to labor-saving devices. But these factors have a negative impact on a woman’s hormonal balance and overall health, and may ultimately be linked to her seemingly “sudden” menopausal symptoms and “sudden” ill health.
The underlying impulse to stay “natural” is a good one, but women who are saying this may not be thinking the issue through. How far would you be willing to take the “It’s not natural” idea? Does this mean saying no to lotion for dry skin? No to lubrication for sexual comfort? No to vitamins? Staying “natural” need not mean rejecting the use of beneficial and safe products to counteract the toxicity of our environment and food supply and help balance hormonal function.
Many of the women who resist the idea of taking anything at menopause don’t realize that at the same time they may be unquestioningly taking a variety of prescription drugs, such as the acid blockers Zantac and Tagamet, which are potentially harmful and hardly natural.
If saying “I’m not going to do anything for menopause, it’s not natural” is just providing yourself with an excuse to stop taking care of yourself, well, unfortunately, there’s nothing we can do to stop you. But acceptance of a normal and important passage of your life is not the same thing as giving in to aging–that is, allowing yourself to slowly balloon out, forget about sexuality, and then eventually sit down for good.
There are women who believe that God meant us to have low hormonal levels after a certain age, so that’s how it should be. But think about this: Many Japanese women on their traditional diet have phytoestrogen levels in their urine that are 1,000 times higher than those of U.S. women. This high excretion level means that their diet is so rich in beneficial plant food that all during their lives they have been “supplementing” their hormones naturally. When these women reach menopausal age, they don’t have the symptoms so common to Western women. And if this were not reason enough to follow such a diet, these women rarely get breast cancer.(6)
The plants are much smarter than the man-made synthetics. They help you to up-regulate and down-regulate your hormone levels naturally. Unlike Premarin, which contains estrogens that are foreign to your body, and which may slow down the process of excretion, the plant substances are excreted very quickly. This is important because the longer an estrogen foriegn to humans stays in the body, the more opportunity it has to cause you problems in the form of side effects.
Our need for hormones continues through our lifetimes. So yes, menstruation will cease, yes, your ovaries will no longer be producing estrogen and progesterone the way they used to–but hormones will still play a very important part in maintaining your bodily functions. And keeping their levels appropriate and balanced with diet and supplementation will support you healthfully and vitally through old age.
But Grandma Never Took Hormones . . .
Women concerned about whether hormone replacement is “natural” often argue that previous generations seemed to have gotten along fine without it. This is a very good point, and again speaks to the confusion created by the drug industry and the medical establishment. Pharmaceutical companies have worked hard to induce a fear state in which women begin to think their bones will turn to dust and their hearts will stop working if they don’t take their prescription drugs for the rest of their lives. These claims are indeed worthy of a good deal of skepticism, especially if the drugs come with significant expense, side effects, and cancer risks.
However, there is still good reason for you to pay attention to your “hormonal health” by balancing and replenishing with plant-derived hormones. Why? Because you and your grandmother may be different in very important ways.
First, we don’t really know the exact state of your grandmother’s health. Just how healthy is she? Just how active is she? How does she look for her age? And given the reticence of previous generations on matters pertaining to their bodies, it would be hard to know what she may or may not have suffered during menopause. “The Change” has only recently become a topic of public or even private conversation. Also, we don’t know what her diet consisted of. If she ate a healthy, preservative-free diet concentrated on fresh vegetables and fruits, then she got a plant-hormone-rich infusion all her life and didn’t need to supplement. If she was active and worked her body regularly, then she got enough exercise to keep her bones strong and healthy.
But now we’re talking about you, her granddaughter. If you’ve lived on processed foods and your dietary habits run to Häagen-Daz, coffee, and hamburgers on the run, if you don’t move that body of yours but instead spend most of your day behind a desk, if you’re supermom juggling a career and family, if you diet incessantly, yo-yoing up and down, if you’ve taken lots of antibiotics and prescription drugs, then you can’t compare yourself with your grandmother. Genetics is only one factor, and may not be the biggest influence. Sure, if you and your grandmother are both lucky genetically, then she may have sailed through menopause and so might you, but there is no guarantee that this will happen to you. A whole different set of contemporary factors comes into play. For starters, your grandmother didn’t have to fight off the onslaught of the pollutants of our present environment. She did not grow up on a diet of commercially grown food lacking in nutrients–especially essential minerals–and, unfortunately, very rich in pesticide residue, drugs, and chemical contaminants. And no previous generation has faced today’s unique stress levels.
But this does not mean that your body is not biologically and genetically prepared to live to a ripe old age.
Living Longer . . . and Better
An insidious idea has taken hold in the menopause literature: We are told that because women are living longer than ever before (supposedly without precedent in human history), a woman’s body after fifty is, so to speak, hormonally unprepared to live very much longer and cannot protect itself against the ravages of old age. This idea has been embraced by the medical profession to justify putting women on permanent HRT beginning at age fifty.
In previous centuries, the mean age of death for women may have been very low as women died as infants, as young children, in childbirth, as victims of epidemics, in famines, in war, etc., but this does not mean that these women were not biologically prepared to live very long lives. Medical anthropologist Margaret Lock, writing in Lancet in l990, said: “Since there is evidence that people have lived to a very old age for at least l00,000 years, this means that from an evolutionary point of view the female body is biologically prepared to do so. The maximum life span potential for a woman is estimated to be about 92 years.”(7) (The authors add: “We feel even this is short–and not the actual longevity potential. To prove our point, the oldest known person living today is a 120-year-old woman residing in France.”)(8)
In the early fifties, certain doctors began to define menopause as a disease–“estrogen deficiency” disease–which then needed to be treated with a drug. Traditional Asian medicine–which, by the way, is based on a “clinical trial” of at least a 2,000-year heritage and 400 unbroken generations of written patient experience–views menopause in an entirely different way than does standard medical practice in the United States. To the Asians, menopause is a necessary and vital process for the body’s health. While obviously a signal that the woman has reached a certain age, passing through menopause actually serves to slow down the aging process by preventing the unnecessary loss of blood and jing, or essence, thus allowing the woman the possibility of good health for at least the next thirty years of life. To ensure a smooth passage in this “second spring” of a woman’s life, Chinese doctors will prescribe tonics and other herbal remedies to balance the woman’s hormones.(9) For thousands of years, Chinese women could live to a healthy old age–and what’s more, they were venerated for it!
Looking Younger Than Ever
What has become evident in the United States is that women act and look younger for their age than in previous generations–forty today is what thirty was twenty years ago. Actresses can now actually be sexy onscreen past forty–Susan Sarandon, Jessica Lange, and Meryl Streep, to name just a few–which was not true a generation ago. Marilyn Monroe was considered over the hill at thirty-six. And now fifty for a woman is what forty was twenty years ago.
What’s the secret? One thing we know is that these contemporary actresses are taking very good care of themselves. In fact, American women in general are taking advantage of a physical youthfulness that has been biologically possible for a long time. And they don’t want to sink into the “Age fifty plus spends her life in the doctor’s office” syndrome.
We’re on the side of looking good at any age. We believe there is such a thing as healthy vanity. Wanting to look and feel beautiful is a woman’s right. Some women have defensively embraced the idea of an old age with wrinkles and without sex. That’s certainly an option. But any expectation you may have that after fifty you will turn into an old woman sitting on a park bench talking about her ailments is the function of an acculturated image. It doesn’t have to be that way.
But the first step in taking full charge of your “second spring” is getting on good terms with your hormones–that is, understanding how they work in your body, and what you need to do to keep them balanced–and most important, learning how the plant-based diets and herbal medicines have supported human life for millions of years and are crucial to the well-being of women.
1. Egon Diczfalusy, “The Early History of Estriol,” Journal of Steroid Biochemistry 20, no. 48, 945.
2. Alvin H. Follingstad, “Estriol, the forgotten estrogen?” Journal of the American Medical Association 239, no. 1 (January 2, 1978): 29-30.
3. B. Sherwin and L. Kampen, “Estrogen Use and Verbal Memory in Healthy Post-Menopausal Women,” Obstetrics and Gynecology 83, no. 6 (June 1994): 979-83.
4. Reuters news release, November 5, 1996. Premarin described as “most widely prescribed drug in the U.S.”
5. Sheehy, The Silent Passage, 207-8.
6. Herman Aldercreutz, et al., “Dietary Phyto-estrogens and the menopause in Japan” (letter) Lancet 339 (1992): 1233.
7. Margaret Lock, “Contested meanings of the menopause,” Lancet, May 25, 1991, referring to K. M. Weiss, “Evolutionary Perspectives on Aging,” in Other Ways of Growing Old, P. T. Amoss and S. Harrell, eds. (Stanford: Stanford University Press, 1981), 25-28.
8. Jeanne Louise Calment, born February 2, 1875, living in Arles, France.
9. Honora E. Wolfe, Menopause: A Second Spring (Boulder, CO: Blue Poppy Press, 1993), 26-28.