HRT – GOING, GOING, GONE?
Since landmark research a few years back, the cat has finally gotten out of the bag on hormone replacement therapy. As was widely reported, a large, longterm federal study on HRT was halted because the women taking hormones in the study had a clear increase in the incidence of breast cancer. Actually, it wasn’t only cancer: the study showed that there was also an increased risk for heart attacks, strokes, and blood clots.
Millions of women have gotten the message. Pharmaceutical companies are reporting dramatic drops in sales of the estrogen containing drugs that once were touted as the latest medical miracle, and even up until a few months ago were often routinely prescribed for women for no other reason than that their periods had stopped.
An October (“Breast Cancer Awareness Month”) meeting sponsored by the National Institutes of Health put an exclamation point on the July findings. Here are some tidbits from a New York Times report (“Cancer Risk of Hormones May Linger”, by Gina Kolata; NY Times; Oct. 23, 2002) on the the meeting:
“Scientific evidence has not shown that women can avoid the breast cancer risk from hormone replacement therapy by taking the drugs for only a short time, researchers said today. It also has not shown that the risk disappears as soon as the drugs are stopped…. “
“Even women who took the hormones for some period but then stopped had more breast cancer than those who never took the hormones.”
“… (researchers) also cautioned against assuming that the risks of hormone replacement therapy end when a woman stops taking the drugs…. other hormone treatments can have delayed and lasting effects.”
The basic message of the meeting was that HRT is harmful and, just as bad, “it is impossible to pick out individuals most likely to be harmed or benefited by hormone replacement therapy…” In fact, the researchers found no reliable way to identify women whose risk is low, even those who were considered to be at a low risk for breast cancer.
The article goes on to report that the message “was one that many doctors, researchers and drug company executives in the crowded meeting today did not welcome.” It led to many “politely phrased questions in the public sessions and in heated discussions in hallways.” I bet…
It appears that some attendees argued that the excess statistical risk of developing breast cancer due to HRT (8 new breast cancers per 10,000 women per year) was “tiny”. This is an argument often proposed in similar debates that swirl around vaccinations. I suppose that depending on one’s point of view, this might seem to be an acceptable rate of ‘collateral damage’. Except, of course, if you happen to be one of the 8 in 10,000’s or her spouse, child or …
I have found that what used to be a tough sell — suggesting to women that indiscriminate use of hormones can have negative consequences, is no longer falling on deaf ears. In an age when our external and internal environments are awash in toxic forms of estrogens, known as “estrogen mimics”, women can no longer assume that estrogen containing drugs are safe. As a matter of fact, that is not limited to HRT and estrogen.
The hormonal system in our bodies is maintained in a delicate balance through an incredibly complicated system of “supply and demand” and feedback loops. When hormone levels shift, there is a ripple effect throughout the entire body. Changing the hormonal balance can have far ranging and unforeseen consequences.
For instance, Tamoxifen is a widely used drug over the last 20 years that is taken orally. It works by interfering with the activity of estrogen and has been prescribed to treat both advanced and early stage breast cancer. Recent research has shown that it increases the risk of cancer of the uterine lining. Even women who take the drug for five years and then stop are at increased risk for this cancer for another decade.
The birth control pill is not as benign a drug as many might think, either. After all, the Pill is a hormone drug – either estrogen, progestin (a progesterone-like synthetic) or a combination of the two.
For years, it has been implicated – and I have seen plenty of clinical evidence to support this claim – in promoting fungal overgrowth both in the intestines and throughout the body. This systemic yeast or candiasis infection can lead to a host of problems, the most common of which are impaired digestion, compromised immune system, mood swings, menstrual disorder and, of course, yeast infections.
The candida connection is probably just the tip of the iceberg in terms of side-effects. My guess is that, just as in the case of HRT, researchers will find that there are even more serious consequences associated with its use.
It is sometimes difficult to suggest to a person that she ought to avoid the Pill, especially if it is a young, sexually active woman. Who wants to be responsible, indirectly, for an unwanted pregnancy? On the other hand, who knows what the consequences of using the pill will be for that young healthy woman years down the road?
As a practitioner, the best option is to educate people about possible consequences related to its use as well as possible options. Certainly, I am less ambivalent about prescribing the Pill as a drug to regulate periods, control facial acne and other symptomatic treatments because there are many truly curative and safe ways to approach these types of problems.
So, putting the birth control issue aside, if HRT is no longer an acceptable option, the central question becomes what is a woman to do in the absence of prescribed estrogen or estrogen combination drugs?
With all the recent bad publicity surrounding hormone replacement therapy, many women are searching for a different approach to deal with menopause and related issues.
First, it is important to keep in mind that menopause is a natural stage in life and not a disease. Menopause per se does not need to be treated. What does need treatment is a person who is out of balance – mentally, physically and/or emotionally. The hormonal changes that occur before, during and after menopause have a tendency to exaggerate those imbalances, leading to discomfort by way of any number of symptoms.
So, “treating” menopausal symptoms basically falls into two categories: addressing the underlying imbalances that are exposed during menopause and smoothing out the hormonal changes occuring around that time in life. The former is a more fundamental — in homeopathic terms, a more constitutional treatment, while the latter is more symptom specific.
In homeopathy, we have the opportunity to analyze and choose remedies focusing on either the constitutional or symptomatic level. For instance, a woman who complains of very intense hot flushes with an accompanying throbbing head might do very well with a dose of Glonoine – homeopathically prepared nitroglycerine.
Read a description of the relevant symptoms written by J. T. Kent, one of our great 19th century masters: (She) complains of a surging in the head, a warm glowing sensation in the head or a feeling of intense glowing from the stomach or from the chest up into the head, attended at times with loss of consciousness. There are also wave-like sensations in the head, as if the skull were being lifted up and lowered, or as if it were being expanded and contracted.
Glonoine is in fact of great use in many cases of intense menopausal symptoms – as well as a frequently needed remedy for sunstroke, angina pectoris, arrhythmia, hypertension, convulsions, headache, and meningitis, amongst other conditions.
Another similar remedy Sanguinaria, commonly known as “Blood Root” and a member of the poppy family (Papaveraceae), is also a useful menopausal remedy. Although there are similarities with the symptom picture of Glonoine, it is not the same. For instance, while we read that the flushes of heat in Glonoine move from the abdominal area upward, the flushes of Sanguinaria move from the head downard into the stomach.
Parenthetically, it is interesting to note that an awareness of similar exact details related to the complaint are often the key to the selection of a successful homepathic remedy. That is why homeopaths often seem to revel in seemngly inconsequential minutiae of a patient’s symptoms.
N.M. Choudhuri, a high regard homeopath in India during the early part of the 20th century described the use of Sanguinaria in the treatment of menopause as follows: “It is specially indicated in climacteric disorders (an old term for menopausal problems) such as hot flushes, burning of palms of hands and soles of feet, fetid corrosive leucorrhoea, enlargement of the breasts, vertigo, menorrhagia, metrorrhagia, and a host of similar ailments that generally make their appearance at this critical age.”
Notice that the “picture” of both remedies described above narrowly focus only on the symptom level of menopause itself. In contrast, there any number of remedies which look at the broader, constitutional level.
For instance perhaps the most common remedy used constitutionally in menopause is a preparation of snake venom known as Lachesis. The picture of this remedy is very distinct and multi-faceted. When choosing this remedy, there are many clues and characteristics that have little relationship to hormonal or gynecological systems. One contemporary writer describes the Lachesis nature as follows:
“Sharp-tongued, witty, bright, censorious, jesting, satirical [very entertaining but tiring]. Fascinating and charismatic, or ruthless, remorseless, tactless directness. Overactive mind. Great command of language. Learns foreign languages easily, or loquacity [wants to talk all the time; jumps from one idea to another; one word often leads into another story], bombastic, exaggerating, loud, rambling. Strong-minded, opinionated. Haughty, fanatism[especially about religious issues].
Suspicion, jealousy. Intense, passionate. Goes to extremes. Vivid impressions, fanatic disapproval.
Warm-blooded, left-sided aiments;or left extending to right.
… Worse Menopause [cessation of menses]. “Never well since menopause.” Circulatory disturbances. Purple, bluish discolorations.
Choking from clothing around neck, from slight pressure or touch.”
(from Vermeulen’s Synoptic Materia Medica, vol. 1)
Another leading “female remedy” is a preparation of the ink of the cuttlefish, known as Sepia. The same writer characterizes this remedy as follows:
“Mental stasis: confusion, absent-minded, dullness, thinking difficult.
Desire to be alone. Indiffernece to loved ones. Negative attitude. Inability to give love and affection. No attachment, no commitment.
Iincommunicative; defensive. Weeping when telling symptoms; or just uncontrollable weeping without giving any information [overwhelmed by sadness, no ability to think clearly.
... Better when busy. Fault-finding, fretful, sarcastic, spiteful, striking, worse before menses.
Very chilly. (Feels) better with physical exertion.
Ailments related to hormonal changes [menses, pregnancy, menopause, puberty, postnatal, the pill]… No sexual desire, no orgasm…
Physical stasis: circulatory disturbances; constipation; bearing-down sensations; emptiness in stomach; great lack of energy. Never well since the pill. Raynaud’s disease.”
Although Lachesis and Sepia are commonly used for the same disorder, menopausal symptoms, clearly they pertain to two very different natures. They will only be effective as “menopausal remedies” if the overall picture of the person matches that of the remedy.
It is on the differences between our patients —that is, their individual natures — that homeopaths place the greatest emphasis and from which homeopathy, as a healing art, derives its greatest strength.
There is no shortage of possible ways for a woman to deal with symptoms of menopause without resorting to hormone replacement therapy (HRT). Homeopathy, acupuncture, botanical (herbal) and nutritional medicine are some of the most widely used and effective therapeutic modalities.
In addition, lifestyle factors also play a very important role in determining the well being during this period of life. It is essential to take into account the level of physical exercise as well as the effects of stress on hormonal balance.
A common thread that runs through most non-pharmaceutical approaches to menopause is an emphasis on liver function. This organ has a critical role in protecting the body from toxins, metabolizing fats, stabilizing blood sugar and maintaining hormonal balance. The maintenance of appropriate weight, cholesterol levels and blood pressure are all influenced by the state of the liver.
The relationship of proper liver function and a smooth transition into menopause has been recognized by oriental medical practitioners for centuries. In that paragdigm a congested, overburdened liver loses its capacity to adequately circulate energy throughout the body. Instead, the blocked energy consistently moves upward into the shoulders and head, causing heat and constriction in the upper body while the lower body becomes energetcially empty.
This is what is known as “Liver Yang Rising” . Typical symptoms in this pattern are dizziness, agitation and irritability, weakness of the waist and knees, hot flashes, perspiration, heavy bleeding during the menses or possibly metrorrhagic bleeding between or in the absence of the menses.
Modern life places an enormous burden on the liver. This is due to a number of factors. Most drugs and other pharmaceutical agents such as the birth control pill are metabolized through the liver. Likewise, pollutants found in our environment and food sources also find their way to this organ. Caffeine, sugar, trans-fatty acids found in margarines are also major factors — as is the everyday stress of our fast paced existence.
Whatever the form of treament, be it acupuncture, herbs, homeopathic remedies nutritional supplements, or diet, detoxifying and stimulating proper liver function is most often a crucial first step toward navigating the “change of life”.
Along with improving liver function, another common thread in the non-pharmaceutical approach to menopause is the re-establishment of the balance between estrogen and other hormones.
A common misunderstanding is that the symptoms of menopause are a result of insufficient estrogen. In fact, there is evidence that the contrary is true. “Estrogen dominance” is a term used to describe a hormonal imbalance where there is relative over-abundance of estrogen in comparison to the other main female sex hormone, progesterone. A large percentage of women experience menopausal symptoms – as well as premenstrual symptoms – as a result.
As one widely recognized nutritional and hormonoal authority, Ann Louise Gittleman, wrote: “When there’s too much estrogen and not enough progesterone, you will be getting symptoms sometimes called the “PMS fom Hell” like mood swings, anxiety, irritability, water retention, thyroid problems, loss of hair and depression”.!
These symptoms first tend to become exacerbated somewhere from five to ten years before the onset of menopause itself, usually during a woman’s late thirties and forties. This stage, known as “perimenopause”, is what Gittleman describes as a “brand new stage of life somewhere between puberty and menopause that is new to the baby boomer generation and the kids of the baby boomers”.
One of the probable causes of this brand new stage, according to many researchers, is that our immediate environment is awash in toxic forms of estrogen, known as “estrogen mimics”. Found in petrochemicals, plastics and in common items like nail polish, lawn and garden chemicals, and all sorts of cleaners, these substances disturb the natural hormonal balance of estrogen and progesterone. Other causes of estrogen dominance are skipping ovulation, excess body fat (greater than 28%), and too much stress and a diet rich in refined carbohydrates and deficient in nutrients and high quality fats.2
1. Gittleman, Ann Louise. A Grain of Salt News, Fall 2002. page 11
2. Northrup, Christine, MD. at