Estrogen worries me. It worries me because I am a man who loves the women
in his family, and many of those women have been taking estrogen because their doctor told them it was the best thing since
sliced bread.
My grandmother was put on estrogen, because she has osteoporosis. She is
89, and stopped taking it because she didn't like having her time of the month after so many years without it. My mother took
estrogen, and stopped because she was worried what it would do to her. As a Naturopathic Doctor, I was concerned about the
effects of adding hormones to their bodies, and I couldn't understand why the medical establishment constantly cited the benefits
of estrogen without weighing the risks. Every woman I knew over forty-five was given a blanket prescription: from menopause
to pill.
Then last month the U.S. National Toxicology Program put estrogen on the
list of known carcinogens. It shares space with mustard gas and lead. The carcinogen listing follows the Women's Health Initiative
(WHI) study, which stopped their authoritative estrogen replacement study early because Prempro, a mix of estrogen and progesterone,
was actually killing women. The study included sixteen thousand women in forty different medical centers. It was supposed
to prove, once and for all, that supplementing estrogen and progesterone after menopause benefited women and that the benefits
outweighed the risks. What they found was that estrogen increased heart disease, stroke, and breast cancer risk, and should
not be recommended for long term use. The U.S. government just announced mandatory warnings on all Prempro packaging. In September
the British medical journal Lancet cited four large scale studies that show the overall risks of estrogen replacement therapy
outweigh the benefits.
But MDs and DOs keep on prescribing estrogen for menopausal symptoms, because
there isn't anything else. Or rather, there isn't anything else that can be patented. A study just came out in November on
Black Cohash, which doesn't have estrogenic effects but still helps with menopausal symptoms. It also contains nine separate
antioxidants that block breast cancer formation in mice. Vitex, which may have estrogenic effects, also has compounds that
are toxic to breast cancer cells. It is an ideal time for a large scale study of the herbal alternatives for menopause. We
need a solution from alternative medicine.
Numerous other interventions also have benefit for menopause symptom sufferers.
Smoking, alcohol, anxiety levels and stress all affect the intensity of hot flashes. Relaxation, exercise, avoidance of triggering
factors, and control of external environment can all be helpful. Multiple alternative therapeutics can be included in the
diet or added as supplements.
The WHI study did find that estrogen lowered the risk of osteoporosis.
The only reason to keep prescribing it is that women all need strong bones. Except most of the women I have seen have never
had a DEXA scan to see if they were at risk for osteoporosis before they got their prescription. None were told to get a minimum
of Vitamin D every day, especially in the winter months. Not to mention all the micronutrients necessary for bone formation.
If the goal is insure that women have strong bones despite the other health risks of replacement therapy, a DEXA and a multiple
vitamin should be mandatory. A discussion of osteoporosis should also include extension exercises which significantly lower
the risk of compression fractures.
For me and my family, the estrogen therapy revelation has been a wake up
call to trust our own intuitions about what makes sense and what does not. Blanket estrogen replacement therapy suffers from
the "one size fits all" idea that doesn't work anymore. But we cannot expect doctors who were trained to treat menopause as
a disease to make the switch rapidly. Several medical articles talk about the shock the medical establishment is going through,
because for over a decade menopause has been seen as a lack of estrogen that must be treated regardless of symptoms. While
they make the transition, we must look for alternatives. Alternatives that make sense for us and help us maintain health.
Dear Doctor Terri Vanderlinde, FACOG,
Hello. My name is Christopher Maloney, and I am a naturopathic doctor practicing
in Portland. I wanted to respond to you, because I respect parts of your position and I have the highest respect for your
dedication to your practice and patients. It seems to me that you are the ideal person to expand the use of viable alternatives
for menopausal symptoms. I would welcome an opportunity to discuss the herbal alternatives, as the current evidence shows
they are an excellent adjunct to short term estrogen replacement for menopausal symptoms.
Reading back over my article, I realize that in writing to the layperson,
I was overly harsh on my MD and DO colleagues. I apologize for putting you all in the same boat. In Oregon, where I was trained,
the standard patient ob/gyn visit rarely exceeds fifteen minutes, and much of it is done with hand on door. I was pleasantly
surprised to learn from you that extended visit times are much more the norm here in Maine. I applaud you for your comprehensive
approach to patient health.
While in retrospect I agree my article might be frightening, I think it
is fair to say that the scare tactics are not mine. It is the U.S. Toxicology Program that has listed estrogen as a known
carcinogen, on the same list as lead, mustard gas, and a wide range of chemical compounds better known to you and me than
the public (please see the list at http://ehp.niehs.nih.gov/roc/toc10.html). Two articles in the Portland Press Herald
trumpeted this development before my article came out. Estrogen is a natural body substance, but compounds from nature can
be the most toxic. They can also be the most powerful when used correctly.
I applaud you for routinely ordering DEXA scans. My grandmother did not
receive one before being put on ERT in 2001 at the age of 88. If the women I see are receiving them, they either don't remember
them or the test is not described to them as measuring bone loss.
If you read back over my first paragraph, you would see that the women
in my family all made their decisions about ERT without my interference. While I fully understand your anger toward the patriarchal
attitude taken by many medical practitioners, I do as you do, spending anywhere from an hour to an hour and a half with my
patients. It is they, not I, who decide what course of action they would like. By the way, my mother (who was visiting us
when your article came out) said you had a great article but she didn't like the words "easily" and "hysterectomy" in the
same sentence. It was she who convinced me to become an ND, where 80% of my colleagues are women.
As for suffering in silence with the pain of vaginal dryness, the compounding
pharmacy here in Portland does a remarkable job of compounding topical ERT ointments that provide relief without systemic
effects. Hot flashes are commonly controlled with a combination of black cohash and vitex, which have the advantages of both
providing symptom relief and blocking breast cancer. If I cannot provide relief, I refer for ERT to my patients' ob/gyns.
I am startled that you can disregard the WHI study and look forward to
taking estrogen. In many cases, the symptom picture of menopause can be effectively treated with lifestyle changes and herbal
therapies. Currently estrogen is only recommended for short term relief. I believe recent studies have called into doubt estrogen's
benefits for Alzheimer's and colon cancer, and certainly an increased risk of stroke and heart disease, already much larger
killers, cannot be ignored. Which leaves estrogen's only benefit to bones, which can be treated long term with Fosomax. I
cannot see any reason for a woman without active symptoms would want to be on ERT at this point.
All this hinges on the idea that the WHI was a valid study. The FDA and
the branches of the U.S government have weighed in that ERT is as dangerous as I stated. While I have read numerous comments
attacking the WHI study, the fact remains that it is now the standard. I doubt if other studies of its magnitude will be undertaken.
Yes, I have read the studies leading up to it, and it was truly a stunning turnaround.
I never said estrogen was evil. The point of my article is that there are
other alternatives that women can try. Mine was not an article of despair, but an article of hope.
If you would like supporting studies on anything I have said, or if you
would like to get together sometime and talk about alternative therapies, let me know. If you are ever up in the Portland
area, I would welcome a debate over lunch.
If I have patients in need of an ob/gyn in the York area, I will be sure
to send them to you. It's rare to find someone so dedicated.
All the best,
Chris Maloney, ND
