On a recent trip to the United States, I was distressed to find nine of my friends had breast cancer and most of the others were taking some kind of hormone replacement therapy. I spent 20 years in experimental cancer research and have an understanding of the process based, not on clinical research data presented in the media, but on experiments in animals.
My attitude is different than either the MDs trained in western clinical medicine, or the alternative medicine advocates. As a result of my experience in research, I am not impressed with how much we know, but with how little we know. Over and over again, we planned experiments based on what we already knew, only to be surprised by a completely different result than expected, which led us to many more questions.
I am also impressed with the remarkable ability of the natural body to heal itself. As we answered some of the questions raised by our work, we uncovered more and more layers of complexities of the natural system. It led me to become very conservative in regard to my medical decisions, only intervening when absolutely necessary, when the effects are well known.
Both the MDs and the alternatives seem arrogant to me, advocating treatments based upon a few known facts, assuming all is known. There are many examples of new drugs presented as wonder drugs that turned out to have disastrous effects. Estrogen is a good example of such a wonder drug. The first estrogen craze lasted from the mid 1960's through 1975 when it was discovered that among women taking estrogen there were as many as ten times more cases of endometrial cancer than among other women.
Estrogen caused endometrial cancer because it prepares the uterine lining, the endometrium, for implantation of the embryo. In the natural cycle, estrogen is opposed by progesterone. Without the opposition, the endometrial layer just kept increasing, an unnatural level of growth for an adult. It is not surprising that some tumor cells arose under those conditions. The current estrogen fad is called hormone replacement therapy (HRT) because progesterone is also given in addition to estrogen. This avoids the high incidence of endometrial cancer. No woman with a uterus should take estrogen alone!
When my doctor glanced at my age - 49 years - and said it was time to get me started on my HRT, I was shocked! I had been living out of the United States and was not subjected to the youth obsession. Elders are respected and honored for their wisdom and experience here in Belize. Nor had I known of the current trend of treating menopause as an illness. I had not yet even had any menopausal symptoms.
When I did begin to skip periods, I was proud, as if it were an accomplishment. I had looked forward to menopause ever since I heard several women describe that wonderful even, high energy which Margaret Meade called "PMZ - postmenopausal zest." Besides, I have a chronic illness, chronic fatigue syndrome, the symptoms of which vary within the menstrual cycle. I expected that my condition would improve when my estrogen and progesterone levels began to drop. And, indeed, my expectations were met!
To convince me to take HRT, my doctor gave me a brochure produced by Wyeth, a pharmaceutical company. I was offended and insulted by the manipulation and misinformation I found there. Then I found that my friends were convinced by these same arguments and realized that I had a different perspective.
I felt alone and a little crazy to be so far from mainstream thinking, like Cassandra, the prophetess of doom. I was relieved to find similar opinions in the brochure by the National Women's Health Network called Taking Hormones and Women's Health and have ordered several copies for friends. But still I feel compelled to speak my mind, so here it is.
I believe that expectations are the key here. The women in the U.S. are bombarded by the drug company propaganda which tells them that menopause is a new disease called "estrogen deficiency." If menopause were a disease, it would not seem strange to prevent it. Some doctors are recommending that women take HRT for the rest of their lives, effectively preventing the "change of life," and promising to keep them in a perpetual stage of youth.
But menopause is not a disease! It is a natural transition like puberty, which has evolved over millions of years along with human rational thought and behavior. The menstrual cycle is a compromise between maintenance of women's health and provision for reproduction. Two disadvantages of the cycle are the monthly depletion of blood which must be replaced and the presence of hormones needed for growth of the fetus. Growth at that level in adults is cancer. Thus, menopause is a natural mechanism that removes these disadvantages after the reproductive phase of a woman's life is over.
A woman has a finite number of eggs available for her lifetime. When they begin to run out, estrogen and progesterone, the two hormones required for implantation of the embryo and successful gestation, begin to decrease. They are still made in smaller quantities by the adrenal glands and estrogen is made by fat cells. The other two female hormones, luteinizing hormone and follicle-stimulating hormone, continue to be produced at constant, relatively high levels, which accounts for PMZ. Taking HRT prevents menopause and maintains a menstrual cycle for as long as it is taken.
Since menopause is a natural process, beneficial to the health of women, a different approach needs to be taken. We should facilitate the transition while treating the disturbing symptoms such as hot flashes, sleep disturbance, and mood swings. While taking HRT does relieve these symptoms, they return whenever the HRT is discontinued, so it merely delays the transition unless the woman intends to take HRT for the rest of her life.
Menopause is not new! The HRT brochure implies that ours is the first generation to live past menopause, using the average life expectancy data of less than 50 years earlier in this century. But average life expectancy is just that - an average. Those dying early in life from infectious disease are balanced against those living out their full life. The increase in life expectancy in this century is not due to an increase in the full life potential, but to improvement in medical treatment for infectious disease. My grandmother's grandmother was born in 1849 and lived to be 100 years old. My grandmother is now 100 years old. Both of them lived half of their lives after menopause without HRT. This has been going on for centuries!
The Wyeth brochure greatly over-states the significance of a study showing that those women who chose to take estrogen had fewer heart attacks. The brochure suggests HRT will prevent heart disease. But the study was for estrogen alone. When progesterone was also taken, the advantage disappeared. Moreover, when the population of women who chose to take estrogen was compared with those who did not, the heart advantage was completely explained by differences in the two populations. Those choosing to take estrogen were at much less risk for heart attacks due to lifestyle choices. Thus, HRT had nothing to do with the heart advantage except that people with less heart risk chose to take it.
The Wyeth brochure admitted that the longterm effects of HRT are not known, but suggested that women take it at least until they were 65 years old, saying that by then we will know the longterm effects. That was not reassuring to me. I am not willing to be the one who proves the disastrous effects of this wonder drug!
Osteoporosis is indeed a serious condition in some women, one which has been treated with HRT because it slows the loss of bone associated with menopause. But again, if HRT is discontinued, the same loss of bone occurs, so a woman must take HRT for the rest of her life for an effective treatment. However, there are now much better treatments that actually replace lost bone. So the threat of osteoporosis 20 or 30 years from now is not a reason to take estrogen.
My biggest concern about the current widespread use of HRT is cancer, especially breast cancer. Cancer is a complex illness with a very long latent period. The initial event is the mutation of a normal cell with limited growth potential into a tumor cell with infinite growth potential. This step involves a change in DNA, the molecules that carry genes. Many of these changes may occur in a normal person, but the DNA itself may be repaired or the immune system may eliminate the tumor cell and cancer is avoided. One way to increase the incidence of cancer in experimental animals is to interfere with these repair and immune systems.
The tumor cells must then have the proper nutrients and growth factors to grow into a full-blown cancer. Estrogen is a growth factor for tumor cells that carry the estrogen receptor, a molecule on their cell surface that binds estrogen. Normal breast cells with these receptors are signaled by estrogen to grow when needed for milk production. Tumor cells with these receptors are dependent on estrogen. In the absence of estrogen, they will not grow and, therefore, cancer never develops.
I remember in the 1970's, when estrogen receptors were first discovered. Women who had mastectomies for breast cancer were also given a complete hysterectomy because it was well known that estrogen encouraged the growth of some breast tumors. At that time only about one-third of all breast tumors had estrogen receptors, so two-thirds of the hysterectomies were unnecessary. The advent of a test for estrogen receptors allowed distinction between estrogen receptor-negative and -positive cancers, eliminating those unnecessary hysterectomies.
Besides the estrogen being prescribed by MDs as part 0f HRT, there are estrogen-like compounds from plants like the wild yam that are available from alternative medicine advocates. Among devotees of alternative medicine there is the belief that plant chemicals are natural and harmless because they are not synthetic.
However, many, if not most, powerful drugs come from plants. It does not matter to the tumor cell whether the estrogen binding to its receptor came from pregnant mare urine, as is the case with the pharmaceutical variety, or was produced from the ingestion of concentrated wild yam extracts. If the signal is given to grow, the tumor cell will grow.
In addition, there are some pesticides and other chemical pollutants which have estrogenic effects, or bind to estrogen receptors. If all this extra estrogen and chemicals with estrogenic effects are causing additional breast tumors to grow, one would expect the proportion of breast cancers that have estrogen receptors to increase from one-third in the late 1970's. In studies being reported today, half of those breast cancers tested are positive for estrogen receptors, an increase of 33%. I expect the proportion of estrogen receptor-positive breast cancers will continue to increase until the current HRT fad ends.
Among the known risk factors for breast cancer are early menarche and/or late menopause. I assume this is because the period of life with high estrogen levels is prolonged. Obesity is a risk factor for breast cancer after menopause, but not before. Since fat cells continue to make estrogen after menopause, I think these women are at risk due to higher estrogen levels. These two facts alone would make me question the wisdom of HRT.
Some doctors do not prescribe HRT for their patients with a history of breast cancer in close relatives, such as a mother or sister. But three-fourths of breast cancer patients have no family history of breast cancer. This only covers a quarter of all the potential patients today.
A recent Nova program on menopause said that estrogen increased breast cancer rates by 20%, while the National Women's Health Network brochure says there is a 30% increase after estrogen is taken over ten years. If this is due to binding of estrogen to estrogen receptors, one would not expect the addition of progesterone in HRT to have any effect and the results bear that out. These data are for estrogen taken for ten years, but some doctors are advising their patients to take it for the rest of their lives - 20, 30, or more years. How many of them will become breast cancer patients?
Assuming the roughly 200 million people in the USA are half female and evenly spread throughout the decades, there are at least 10 million women in their 50's in the U.S. and 1 million of them would have gotten breast cancer before the current HRT fad. That extra 20% is 200,000 additional women with breast cancer! Not only is estrogen a big business, so is chemotherapy. If half of them show cancer cells in their lymph nodes and require chemotherapy, that's 100,000 women at $50,000 each, the average cost of chemotherapy. That's 500 billion dollars of additional medical costs!
Judith Rae Lumb, Ph.D
For more information, contact:
National Women's Health Network
514 Tenth Avenue NW, Suite 400
Washington, D. C. 20004