Over Fifty million women will become new candidates for Hormone Replacement Therapy (HRT) this year. Some may be advised to take synthetic estrogen for thirty years. That would be an approximate 1.5 billion years of prescriptions. Proponents of taking synthetic estrogen boast protection of your heart, prevention of dementia, relief of hot flashes and the prevention of osteoporosis. New research has shown and been given credit in medical journals that HRT may not be providing the benefits as originally thought. It may be in the best interest of many women to consider other, more natural options.

In 1997 concern over the fact that HRT can increase your chance of breast cancer by 40% received some recognition. In 2001 however, the Journal of the American Medical Association (JAMA) and the Journal of National Cancer Institute admitted that HRT use of up to 10 years increased your risk by 8-9% per year. The March issue of JAMA also reported an increased risk of ovarian cancer deaths for users taking the drug over 10 years. In 1998 the Heart and Estrogen/Progestin Replacement Study (HERS) was conducted on women with heart disease who had high cardiac risk. They were randomly assigned either HRT or a placebo. The results expected to show a huge benefit when in fact the study showed no benefit at all for women who have heart disease. After the first year the HERS found a 50% increase in the risk of suffering a non-fatal heart attack or dying of heart disease in the HRT group compared to the placebo group. Since then, an Estrogen Replacement and Atherosclerosis (ERA) trial found similar results, no effect on the amount of plaque in the arteries (atherosclerosis). The randomized trials conducted over the last four years have actually shown an increased risk of heart attack or stroke during the first year or two.

Osteoporosis is the most common bone disease in the United States. Annually, osteoporosis causes 1.5 million fractures and 20% of the women who fracture their hip will die within a year. Many women hope HRT will prevent osteoporosis but recently JAMA analyzed 22 HRT trials by British researchers and found a reduction in bone fracture risk only when HRT was started before age 60. Even this finding is questionable since the studies were not designed to look at osteoporosis. The JAMA analysis urges us to question the efficiency of HRT for the prevention of osteoporotic fractures. Osteoporosis begins long before estrogen levels fall and accelerates for a few years at menopause. Estrogen can slow loss for those few years, but the effect diminishes after a few years since estrogen cannot build bone. In 1995 the New England Journal of Medicine reported that women over 65 using estrogen had no benefit in preventing hip fractures.

Few studies have looked at the effect of natural progesterone on menopausal symptoms and bone loss. Peak bone mass occurs in the mid 30’s, yet a high percentage of women arrive at menopause with osteoporosis well under way. The cessation of ovulation causes a loss of progesterone. Dr. Jeri Prior at University of British Columbia in Vancouver, Washington studied female marathon runners who were developing osteoporosis. The osteoporosis developed when their estrogen levels were still high but they had stopped ovulating, a common occurrence in female athletes, and their progesterone levels had fallen. The lowering of progesterone levels due to anovulatory cycles is epidemic in North America which may be contributing to the alarming rise in infertility among women in their thirties. Osteoporosis can start fifteen years prior to menopause at a rate of 1 to 1.5% per year. At menopause bone loss accelerates to 3 to 5% per year for about 5 years but then it slows down to approximately 1.5% per year again. The accelerated loss at the time of menopause suggests the additional effect of estrogen loss. Since the accelerated loss only lasts for up to 5 years, we can conclude that the estrogen effect is subject to adaptive adjustment by bone cells. If the estrogen hypothesis is true, then why does premenopausal bone loss occur prior to menopause when estrogen levels are still high? We can conclude that estrogen retards bone resorption and progesterone prompts new bone formation. 

Between 1980 and 1989 Dr. John Lee, author of “What Your Doctor May Not Tell You About Menopause”, treated postmenopausal women with diet, natural progesterone cream, mineral and vitamin supplements and modest exercise with amazing success. This resulted in a reversal of osteoporosis even with patients who did not take estrogen. The clinical trials also showed improved blood lipid levels with women on natural progesterone versus synthetic progesterone. 

In 1981 the American Journal of Epidemiology reported the results of a study done by Johns Hopkins Medical School to determine the cancer-protective benefit of progesterone. In 2 groups of women, one with normal levels and one with low levels of progesterone, it was found that the occurrence of breast cancer was 5.4 times greater in the women with low progesterone levels. When the study looked at the low progesterone group for all types of cancer, they found a tenfold increase in malignant cancers compared to the normal progesterone levels group. 

The only known cause of endometrial cancer is unopposed estrogen. Estrogen given to postmenopausal women for 5 years increases the risk of endometrial cancer six-fold and long-term use increases it 15-fold. In premenopausal women, endometrial cancer is rare except for the 5 to 10 years prior to menopause when estrogen dominates. 

For many years women have been told that menopause is an estrogen deficiency disease but estrogen levels only drop 40 to 60 percent at menopause, while progesterone levels can drop to zero. The balance of hormones in the body is nature’s way of protecting itself. These hormones work together while opposing each other by sensitizing receptor sites for each other. Estrogen will make tissues more sensitive to progesterone, and likewise progesterone will do the same for estrogen. When progesterone levels hit zero, it creates estrogen dominance resulting in a hormonal imbalance and a whole host of unpleasant side effects. There are over 5000 known plants that make sterols and have progestogenic effects. Non-industrialized cultures
that ingest fresh vegetables of all sorts, and who are not exposed to xenoestrogens, do not have a progesterone deficiency. They move through menopause symptom free.

Our use of processed foods and foods that are picked unripened lack the beneficial sterol levels and we lose the progestogenic effect. Also contributing to the problem are Xenoestrogens, which are everywhere in our environment. Found in petrochemical derivatives, they are in plastics, herbicides, pesticides, and dioxins (industrial by-products). Some of these are very potent estrogenic substances even at nanogram doses. A feature of these estrogenic substances is the phenolated A-ring of the molecule. This A-ring serves as the molecular key that opens some cells. This A-ring is found in estrogens and xenoestrogens, not in progesterone or testosterone. As a result, each time we come in contact with plastic stored and wrapped food, or estrogenic pesticides in and on our food and in our water, or meat that has been treated with sex hormones for growth promotion, we are getting a small dose of estrogen. Over time the effects will add up and affect our hormone levels. 
It is easy to assume that our lifestyle and environment are strong contributors to estrogen dominance.

Estrogen therapy without progesterone has been linked to blood clotting, uterine fibroids, fibrocystic breasts, gallstones, liver dysfunction, endometrial cancer, breast cancer, and provides questionable benefits to bones. Despite all this, common medicine still perceives HRT to be a good choice. The benefits of HRT are becoming far more suspect as the risks continue to rise with long-term therapy. Natural progesterone therapy has been shown to offer relief of symptoms and can be effective in opposing the dominating and carcinogenic effects of estrogen. Using organic meats and foods, and utilizing glass for food storage and beverages will help minimize the exposure to xenoestrogens and extra estrogen. Natural progesterone therapy, sensible diet, moderate exercise, vitamin and mineral supplementation all deserve far more of our attention and application in the prevention and care of women’s health concerns. 

One step closer to a healthier personal environment is the healthy home. Check out this web site to see how you can improve your home health environment: 
www.themomteam.com/cgi-bin/mom.cgi?id=ca157339&action=show

For other Fit Tip articles or a copy of “Osteoporosis What You Need to Know” you can e- mail me at getfit@afitnesssolution.biz

References:
Hayes, S. (2001, July). Mayo Clinic office visit:
-Hormone replacement therapy and your heart-changing research.
-Hormone replacement therapy revisited.
Mayo Clinic Women’s Health Source, 5, (7) 1-2, supplement
Hopkins, V. & Lee, J. R. (1996). What your doctor may not tell you about menopause.
New York: Warner Books. www.johnleemd.com
Lark, S. M. (2001, Summer). The hormone hoax.
New Choices in Healing for Women, 1-3
Rubin, R. (2001, June 13). Hormone therapy: Doubts grow.

USA Today, p. 1A.