Nicole Spear, MS, CNS
Menopause & HRT Concerns
Updated: Aug 25, 2018
Within the past century, the face of menopause has seemed to evolve from a naturally occurring process that marks the end of a women’s reproductive years, to that of a dreaded condition marking the end of youth and the beginning of old age. In today’s society, menopause is often synonymous with and defined as hot flashes, night sweats, dryness, wrinkles, osteoporosis, heart disease, blood clots, cognitive dysfunction such as Alzheimer’s and “losing one’s mind,” and a loss of youthfulness. This seems dismal indeed! However, the discovery and development of estrogens and hormone therapy seemed to provide the euphoric solution and the key to immortal youth. Unfortunately, these unsuspecting, desperate women had (and continue to have) little knowledge of the fact that they were (and are) prey to money hungry pharmaceutical companies, unconcerned government agencies and doctors in denial. Women entering menopause (whether naturally or surgically) are among the greatest victims in perhaps one of the greatest experiments performed – the estrogen experiment.
Natural menopause usually occurs between the ages of 45 and 55, but may be induced immediately at any age by surgical removal of the ovaries, which is known as surgical menopause. Menopause is marked by the decrease in estrogen and progesterone by the ovaries, which consequentially ends menstruation and a women’s reproductive ability. Hormone replacement therapy (HRT) is the most common prescription for menopause and for many women, it is the only option presented. However, much concern has been voiced, in recent years, regarding the common practice of using HRT for menopause symptoms and its potential risks. For any woman considering HRT, a close investigation into the pros and cons of using such therapy should be embarked upon before making a decision to utilize this treatment option.
Experiments with Hormone Replacement Therapy
The use of hormones as a drug and the opening of the “great experiment” began in 1938, in England, when a biochemist, Edward Charles Dobbs, published his formula for the first synthetic (non-steroidal) estrogen in an effort to prevent Nazi Germany from “cornering the world market on synthetic sex hormones” (p. 4). Unlike many of the scientists and physicians who used Dobbs formula flippantly, Dobbs understood the danger associated with its use as well as its intended purpose on a very small, specific population. On many occasions, Dobbs exhorted physicians to use caution in how and why they prescribed synthetic estrogen to women. Dobbs stated that the “hormones were among the most powerful of drugs, serving a broad, not a narrow, function, and they could alter the metabolism in every cell and organ of the body” (p.41). Further, upon seeing how his original formula was being abused, he warned that “the dosages in the pills appeared to be inexcusably higher than was needed to do the job” (p.42) and he cautioned doctors “to be wary of the pill… [because of] the metabolism, the ovaries, the potential infertility and cancer and birth defects…hormones were to cure diseases, he said, but were dangerous for longtime use in healthy people” (p. 41).
While the “great experiment” exploded for the next several decades, intertwined in this history are stories of unethical uses of hormones by Nazi’s against Jews during WW2, unsuccessful and illegal trials for birth control pills performed on poor, underserved Puerto Rican women by efforts of Margaret Sanger, stories of compromised FDA approvals of estrogen and hormones by skirting FDA policy, tales of birth defect tragedies from estrogen use for the purpose of preventing miscarriage, the ignoring of sound scientific proof of the fate of estrogen users while promoting unsound literature of estrogen’s presumed long term benefits, and the deception of physicians who denied estrogen users the knowledge of its potent effects to prevent lawsuits, to name a few.
Of course, deception cannot continue forever without being exposed and the first deception came to a head in 2002 when the Women’s Health Initiative branch of the National Institutes of Health was forced to halt their 8 year Prempro trial on 16,608 women, after 5.3 years, because of the alarming cases of breast cancer, heart attacks, strokes, pulmonary embolisms, and blood clots among those taking the synthetic hormone.
Hormone Trials and Breast Cancer Perhaps one of the most telling trials that depicted possible pros and definite cons of hormone replacement therapy was the Women’s Health Initiative randomized controlled trials (1993–2004) of conjugated equine estrogens (such as Premarin) and the Women’s Health Initiative observational study (1993-2004). This renowned trial included 27,347 women (the observational study included 93,676 women) and was designed to determine the effects of hormone therapy on cardiovascular disease as well as the benefit to risk ratio. It was presumed that the use of conjugated estrogens in menopausal women would decrease the risk of CVD significantly; however, the trial was closed in 2002, 5.6 years into the 8 year trial, after the discovery of a strong correlation between treatment and an increase in breast cancer.
Not only was breast cancer a concern; it was found that the hormone therapy increased risks for and the time to incident for coronary heart disease, stroke, pulmonary embolism, colorectal cancer, endometrial cancer, hip fracture and death from other causes.
Further, it was discovered that risk ratios were even higher among women in the observational study; particularly for breast cancer, and confirmed the association between breast cancer and the use of conjugated equine estrogens.
The authors of an article published in the Journal of Epidemiology further analyzed the results of the WHI trials and observational study to determine if the duration between the start of menopause and initiation of treatment had an effect on risk outcomes. They found that the effects were unchanged except for the risk of breast cancer, which was increased among women with a shorter duration between the start of menopause and therapy initiation.
A Compromise: Lower Doses and Short Term Use Since the halt of the WHI trials, the use of HRT has declined significantly as many women appropriately fear the risks involved with this therapy. However, the FDA has tried to remedy the situation by recommending HRT therapy in lower doses and for the shortest duration necessary. Further, the FDA has been quick to reveal the studies that show some benefits to using HRT, in this manner, for younger menopausal women, particularly. However, HRT is not approved as therapy for these conditions and neither is its use encouraged in those who may already have risk factors for these conditions.
Population of Concern
It may be evident that women who are at the onset of menopause or who have been surgically induced into menopause are the population of greatest concern. However, I would challenge one to consider that all women and girls, men and young boys, are affected by this great experiment on women. It has now been forcefully proven that synthetic sex hormones are powerful carcinogens (inducing cervical and breast cancer, especially), inducers of blood clots in the legs and lungs of most users, and thus increase risks of stroke and heart attacks. These fates are certainly focused on menopausal women using synthetic estrogens (aka. traditional hormone replacement therapy) and command our greatest attention, but other populations are increasingly feeling the effects as well.
After WW2, the use of synthetic estrogen in cattle became increasingly popular until 80-85% of our livestock was being raised on synthetic hormones by the 1960s for purposes of monetary gain (bigger meat means bigger profit!). The first concern was in a lack of quality control when traces of estrogen pellets were found in meat. With much alarm, it was also discovered that male laboratory workers, who worked in estrogen production labs, began growing breasts. Further, the waste of hormone-dowsed livestock was contaminating major water and sewer plants. In 2002, it was found that 40% of US waterways were contaminated with estrogens and other reproductive hormones, further evidenced by the infertile fish within those waterways that were found to have defective reproduction systems and discovered to be hermaphroditic.
The presence of biological hormones continues to increase in our environment as a result of the ability of synthetic hormones to resist digestion and inactivation within the mammalian body, thereby remaining active in all waste products and affecting both genders.
Another alarming discovery was the influence of synthetic estrogens on children born to mothers who had taken some form of estrogen (particularly diethylstilbestrol or DET) during the pregnancy. Nine out of ten daughters born to these mothers had some form of reproductive cancer and nearly half were infertile. These cancers often affected the girls before they reached their 20s and several of them, as young as 7, had to undergo vaginal biopsies to remove defects and abnormal growths. The effects were not only isolated to females. Many males, born to these mothers, developed rare forms of testicular cancer and had various reproductive anomalies. While there is still much controversy regarding the use of HRT, most reviews will acknowledge that it must be used conservatively, if used at all, and in many studies, risks have outweighed the benefits. As a result, many women have chosen alternative therapies for menopause including the use of herbs, exercise, and if necessary, bioidentical hormones.
Resources: Seaman, B. (2003). The greatest experiment ever performed on women. New York: Hyperion. Potera C. (2008). Hormone replacement: revisiting the risks and benefits. American Journal of Nursing. 108 (6): 21
Prentice, R.L. et al. (2009). Benefits and Risks of Postmenopausal Hormone Therapy When It Is Initiated Soon After Menopause. Journal of Epidemiology. 170 (1): 12-23. DOI: 10.1093/aje/kwp115