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Menopause: The Hormone Conundrum
It’s comforting to think that modern medicine and post-Freud psychology have banished the notion of “female hysteria,” that vague Victorian diagnosis that medicalized the experience of being a woman. At the turn-of-the-century, everything from fluid retention to irritability was ascribed to hysteria; one ambitious doctor of the day even compiled a 75-page list of symptoms. But while, thankfully, the medical establishment’s understanding of women’s health issues has progressed greatly in the past century (though the return of the Victorian cure for hysteria, quaintly dubbed “pelvic massage,” would not be entirely unwelcome), misunderstood and simultaneously over-medicalized niches in women’s health still exist. Chief among them are menopause and its precursor, perimenopause, which can affect women as early as age 30.
Historically, the medical community has treated menopause as a disease, one that, doctors seemed to imply, would be irresponsible not to treat. But in recent years awareness of menopause as a natural process has gained momentum, thanks in part to studies indicating that the liberally prescribed treatment for the symptoms of menopause, hormone replacement therapy (HRT), poses its own significant dangers to women’s health.
While this is great news for the advancement of the understanding of women’s health issues and the normalization of women’s bodily processes, the fact remains that menopause brings with it a bevy of unpleasant and often debilitating symptoms from which women are eager to find relief. And not just for the over-50 set. For some women, perimenopause—the period of diminished estrogen and progesterone production that precedes menopause—can start much earlier and bring with it all the dreaded symptoms.
This culmination of often unbearable symptoms with the dawning awareness of HRT’s dangers has led women to seek new alternative treatments—and product manufacturers have been only too happy to oblige. One alternative therapy, touted for its natural origins and HRT-like efficacy, quickly rose to the top of the heap: bioidentical hormones, or hormones derived from natural sources that exactly mimic the molecular structure of the hormones produced by a woman’s body.
The Trouble with HRT
For the last several decades, hormone replacement therapy, or the use of hormones estrogen and progesterone to treat the symptoms of menopause and perimenopause, including hot flashes and night sweats, vaginal dryness and urinary tract problems—has been considered safe and, at times, even beneficial to a woman’s health (previous studies had shown it to help osteoporosis and lower the risk of developing certain cancers). In 2002, however, the findings of the Women’s Health Initiative (WHI), a project of the National Institutes for Health, considered to be the most definitive long-term study of postmenopausal women’s health undertaken in the United States, overturned the conventional wisdom about HRT.
WHI showed that there were serious side effects to hormone replacement therapy, including a greater risk for developing heart disease, blood clots, stroke and breast cancer. A sub-study of WHI called the WHI Memory study (WHIMS) found that women who used estrogen plus progestin therapy ran double the risk for developing dementia than those who did not use HRT.
The Buzz About Bio-Identical
“There is a lot of interest in bioidentical—or so called “natural”—hormone therapy for menopause symptoms,” says Sandhya Pruthi, MD, a breast-health specialist at the Mayo Clinic in Rochester, MN.
The term ‘bioidentical’ refers, generally, to hormones that are chemically synthesized from natural sources to be identical to those produced by a woman’s ovaries. More specifically, it can be used to denote a “custom-compounded” blend of hormones that is “matched” to the exact output of hormones by an individual woman.
“These over-the-counter products are marketed as being tailored to a woman’s individual needs, typically determined through saliva testing,” says Dr. Pruthi. “Manufacturers claim that bioidentical hormones are safer than standard, FDA-approved hormone therapy.”
Some doctors concur that bioidentical hormones provide a safe and effective alternative to HRT. “Bioidentical hormones are the same identical hormones that our body makes naturally,” says Prudence Hall, MS, MD, of the The Hall Center, a functional medicine clinic in Santa Monica, Calif. “They are extracted from soy and yams and are chemically changed into hormones that are the same as human hormones in every way. As such, when they enter the blood stream they interact with our cells in the same way that our own hormones do.”
Other women’s health experts disagree. “Since the release of the findings of the Women’s Health Initiative, many companies have taken advantage of the climate of fear surrounding hormone treatment to sell alternative products based on the unproven idea that other forms of estrogen will be safer than the synthetic hormones that were studied in the trial,” writes the Boston Women’s Health Collective in Our Bodies, Ourselves: Menopause (Touchstone, 2006). “This idea is based more on the principles of marketing than the principles of science.”
Indeed the term bioidentical is often used synonymously with natural. “But,” cautions practicing traditional naturopath and medical consultant Theresa Dale, PhD, “there is no truth to using wild yam as a source for hormones and having it be natural to the body.” Once it is synthesized in a laboratory, the theory goes, the substance has been altered and is, therefore, no longer natural.
The very idea that the exact blend of hormones in a woman’s body can be tested accurately in the first place is up for debate. Hormone levels are constantly changing throughout the day with the body’s circadian rhythm, says Dale, and that makes it impossible to get an accurate read of the body’s hormone level from one saliva test, the typical (and singular) test a compounding pharmacist performs to determine hormone levels in a woman’s body.
The scientific community is only just beginning to put bioidenticals to the test, but some early results don’t bode well for the so-called “natural” alternative. The findings of the Million Woman Study in 2003 indicated that bioidenticals increased the risk of breast cancer. Another study’s findings released in 2003 reported that bioidenticals did not slow the progression of artherosclerosis.
Alternatives to the Alternatives
Dr. Dale, who has developed her own line of homeopathic treatments for the hormonal fluctuations in the body, says that homeopathy is effective and safe when it comes to treating the symptoms of menopause and perimenopause. She also recommends dietary changes, which, she says, can have an immediate impact. “If a woman eliminates sugar, alcohol and caffeine, it will diminish hot flashes within 24 hours.”
“I felt so much better when I was able to give up caffeine and lay off sugar,” says Pam Myers, 61, of Detroit Lakes, MN, who tried HRT for a year when menopause struck at age 53. After abandoning HRT because of worries about its safety, she tried herbal remedies. “I took black cohosh as an herbal supplement, which helped with hot flashes,” she says.
While the National Center for Complementary and Alternative Medicine (NCCAM), a branch of the National Institutes for Health, is currently sponsoring studies of botanicals and herbal supplements as viable treatment options for the symptoms of menopause, very little scientific research has been done on the subject to date. Most testaments to their efficacy—and their possible dangers—are anecdotal. “There are many potential alternatives to estrogen [hormone replacement therapy],” claimed a 2005 conference statement of the NIH’s State of the Science panel convened to review the management of menopause-related symptoms. “However, their effectiveness and long-term safety need to be studied in rigorous clinical trials in diverse populations of women.”
Among today’s most common alternative treatments sought out by women is the herb black cohosh, which some women have used for relief of hot flashes. Ginseng has been said to help with mood swings and insomnia, and the herb kava is reported to reduce anxiety in people of all ages.
Perhaps the one thing all practitioners, menopausal women and even the State of the Science panel can agree on is that it’s necessary to stop medicalizing women’s hormonal shifts like menopause. “Menopause is medicalized in contemporary American Society,” said the panel, who noting that while continued scientific investigation and medical care should be “focused on women with the most severe and prolonged symptoms,” perhaps the best course of action to help better understand and treat menopause is to let the past guide the future—and to encourage research that focuses on the history of hormonal changes as part of the natural course of an adult woman’s life.
Public health information such as this, continued the panel, “empowers women and increases their self-reliance.” And that might prove to be the most powerful treatment for hormonal imbalances on the market.
Laine Bergeson is a Minneapolis, MN-based writer and editor.