The female hormone, oestrogen, has become a modern myth.
Most women and their doctors now believe that oestrogen makes them sexy, gives them younger skin, banishes hot flushes and depression, halves their risk of heart disease and protects them from osteoporosis. ‘I seriously question this’, says Dr. Lee.
Oestrogen is the hormone that is responsible for the changes that take place in a girl as she reaches puberty. Under the influence of oestrogen her sexual organs mature and she grows breasts, female curves and pubic hair. From then on, for the first half of every month, oestrogen stimulates and builds up the lining of the womb in anticipation of a fertilised egg. It also encourages the growth and lubrication of the lining of the vagina.
This stimulating effect of oestrogen helps to explain why, in excess, it is toxic. Oestrogen stimulates breast tissue: it can encourage the development of fibrocystic breasts, and supplementing with oestrogen is known to increase a woman’s risk of breast cancer. It also stimulates the lining of the womb, the endometrium, increasing the risk of endometrial cancer, and encouraging the growth of fibroids.
Some researchers make light of these factors, claiming that we should offset the slight risk of cancer against the protection the hormone gives from heart disease and brittle bones. But the risk that a woman takes when she supplements with oestrogen is not slight.
Supplementing with oestrogen significantly increases a woman’s chances of getting breast cancer, and her risk of developing endometrial cancer more than trebles.
And does oestrogen reduce a woman’s risk of heart disease? It has long been known that the oestrogen in the contraceptive pill increases the risk of heart and cardiovascular disease. In fact it encourages blood clotting, and makes the body hold salt and water which can lead to high blood pressure (hypertension). Both these conditions will contribute to stroke, embolism, thrombosis and heart attack.
The argument that oestrogen therapy could protect women from heart disease is based on the observation that it lowers cholesterol, but this is no longer recognised as proven protection against heart disease. Furthermore the study, reported in the New England Journal of Medicine (15 April 1993), which led to the claim that HRT almost halves the risk of heart disease was found to be seriously flawed: an editorial in the same journal criticised the study and called it ‘speculative’. In the 1960s there was a trial to see if oestrogen could prevent heart attacks in men. The experiment had to be stopped because their rate of heart attacks increased sharply.
So oestrogen increases women’s cancer risk, and seems to be bad news for heart disease too, but at least we know it prevents osteoporosis, don’t we? No, sadly it does not. A recent study also published in the New England Journal of Medicine (14 October, 1993) concluded that HRT failed to protect women from osteoporosis. Only women who had taken HRT for more than seven years - far longer than most women stay on the drug - had a slower loss of bone density, and even those who had taken it for ten years or more were not protected from fractures.
This is serious news. Millions of women are taking oestrogen in the belief that it will keep them young, when it seems there is a real danger that it might not even keep them alive.
But what about the claim that oestrogen makes women feet good? Because this hormone has become associated with sexiness and ooh la la, this in itself may suggest to women that they feel good on it. There may also be some truth in this. However oestrogen increases the body’s retention of salt and water which can cause bloating and weight gain, factors not usually associated with good feelings; and when the body swells the brain swells too, easily triggering irritability and depression. Depression, pioneering doctors in the field now believe, is closer to oestrogen’s true affect on mood.
Yet there are some benefits to be had from oestrogen. Hot flushes, although not directly caused by lack of oestrogen, can indeed be reduced by it. However hot flushes are triggered by the hypothalamus as a response to low oestrogen and progesterone. In most cases the far safer hormone, natural progesterone, will abolish hot flushes without having to use oestrogen at all. Oestrogen can also be helpful for vaginal dryness although often progesterone will solve this problem too.
In 1994 the Nutrition Line brought to London an American doctor with a revolutionary point of view. For fifteen years, John Lee MD. has been treating women with natural progesterone instead of oestrogen. Natural progesterone, he believes, is the hormone that modern women are most often missing. Far from endorsing the idea that women need extra oestrogen, Dr. John Lee believes that many are already suffering from too much, a syndrome which he has named ‘Oestrogen Dominance’.
Dr. Lee began to recommend a natural progesterone cream to some of his patients after hearing a talk by Ray Peat PhD, professor of Blake College, Oregon. One of the problems with natural progesterone is what to dissolve it in. It doesn’t dissolve well in alcohol, and the solvents that do work can be highly toxic. Ray Peat, who had been studying female hormones for many years, had ingeniously solved the problem by patenting a method for dissolving it in vitamin E. The resulting cream could be applied to the skin and absorbed into the body much more efficiently than taking it by mouth.
Dr. Lee had been looking for some way to protect women from osteoporosis when oestrogen was contra-indicated (for instance after breast cancer). Being open minded, and having no alternative to offer these women, he began suggesting that they apply progesterone cream, hoping that it would in some way help slow down bone deterioration.
To his astonishment, after a few months, bone mineral density [BMD] tests began to show that the women who were using the progesterone cream (and not taking oestrogen at all) had increased their bone density. When he suggested the cream to his other menopausal patients he got the same results.
It is important to realise at this point just how extraordinary this was. Oestrogen, although it may slow down bone loss, can never reverse it. Taking calcium, boron or other nutrients, can help slow down bone loss, but it will not regenerate. No other substance has been shown to restore bone growth. And the reversal with progesterone was not small. Women who had lost a great deal of their bone density, and had already suffered fractures, eventually (over a number of years) regained the bone density of thirty-five year-olds. Thirty-five is about the age when a woman’s bone density is at its peak. Typically Dr. Lee’s patients showed a 10% increase in the first year followed by 3-5% each following year. Even more important, their rate of non-trauma related fractures dropped to zero. Over the years Dr. Lee has treated thousands of women for osteoporosis in this way. His work has been published in the International Clinical Nutrition Review, Medical Hypotheses and the Townsend News Letter for Doctors.
But that is not the end of the story. After they had been using the natural progesterone for a while, Dr. Lee’s patients brought him other information. Those who were still having periods reported that their premenstrual tension had vanished. Others told him that their fibrocystic breasts were clearing up. Women who had suffered from water retention for years no longer needed diuretics.
Women who had been suffering from depression were starting to feel good. Some women with low thyroid function reverted to normal, and women with fibroids found that they shrank or were sufficiently contained that surgery could be avoided.
As the pattern unfolded Dr. Lee began to piece together what was happening. Hormone tests showed him that many of the women were progesterone deficient. This was true even among younger women who should have been producing the hormone. What could be causing this?
Progesterone is the hormone secreted by the ovary in the second half of the menstrual cycle. It is made by the empty follicle (or egg sac) after it has released an egg in the process of ovulation. Under the circumstances, this is a critical event to understand: women only make progesterone when they ovulate; if they fail to ovulate they make no progesterone.
But why should that be so important? The answer has to do with oestrogen. In spite of the dangers, oestrogen is of course a totally essential female hormone while it remains in balance. But progesterone has the role of keeping oestrogen in balance it is said to oppose oestrogen. So when a woman releases no egg during her cycle she will experience unopposed oestrogen, or ‘oestrogen dominance’ a condition which Dr. Lee now believes to be widespread.
The symptoms of oestrogen dominance include water retention, breast tenderness, PMS, mood swings, depression, loss of libido, heavy or irregular periods, fibroids, cravings for sweets and weight gain (especially around the hips and thighs). It was these symptoms that began to reverse when Dr. Lee prescribed natural progesterone.
Progesterone production naturally stops in all women as they approach menopause. Did nature intend all women to suffer from oestrogen dominance? Of course not. Evidence suggests that women living in the third world do not experience the menopausal symptoms common in the Western world. Clearly diet plays a part. It is known that many fresh foods contain progesterone-like ingredients. The Mexican yam, for instance, contains diosgenin a substance which needs only one change to become progesterone itself. The once popular herb sarsaparilla contains another close relative. Dr. Lee believes that traditional diets contained, and in some parts of the world still contain, enough progesteronic foods to keep women in balance right through the menopause and beyond.
A more sinister element is also involved. Not only have most Western women been exposed to synthetic hormones via the pill and other hormone treatments, they also live in a very polluted world. Many of the chemicals in our food and environment, including pesticides and substances found in plastics, hair dyes, cosmetics, spermicides, drinking water and even breast milk are like oestrogen, or oestrogenic, and are capable of having effects similar to oestrogen in the body. They have come to be called xenoestrogens (foreign Oestrogens). Dr. Lee is not alone in believing that men, women and children in the Western world now get a thorough overdose of toxic and highly undesirable oestrogens.
The xenoestrogens are very potent. Dr. Lee believes that one consequence may be that women exposed to these chemicals use up the eggs in their ovaries too quickly, often reaching a state of ‘burn out’ by their mid thirties, far younger than nature intended. After that they would have periods but would no longer ovulate or only occasionally, so that for the next fifteen years or so until menopause they would not be making progesterone and would suffer the symptoms of oestrogen dominance: infertile, uncomfortable and with an increased risk of breast and endometrial cancer.
Interestingly it is also in the mid thirties that osteoporosis often silently begins. And although nutrition and exercise are an important part of maintaining bone health Dr. Lee now believes that osteoporosis is primarily a disease of progesterone deficiency. While oestrogen can only slow down the loss of bone in a very limited way, it is almost certainly progesterone that stimulates the cells, called osteoblasts, that are responsible for laying down new bone.
In view of all the evidence, it does not seem that women should expose themselves to yet more oestrogen by taking HRT. We ask are they not protected by the synthetic progestagens that are included in this treatment? No. Although a progestogen was originally added to HRT formulations to protect women from the increased risk of endometrial cancer, it has been shown to do the opposite. Synthetic progestagens can cause cancer, (unlike natural progesterone which has been shown to be protective), and they have many other toxic side effects.
So what should women suffering from hot flushes, depression, fatigue, middle-aged spread and creeping osteoporosis and nothing but the prospect of a downhill slide do?
In the first place a good diet, high in fresh and preferably organic vegetables, and low in dairy products and meat, will establish a sound base. Women who have eaten healthily for several years, especially vegetarians, sometimes pass through menopause without bother. Xenoestrogens concentrate in dairy and meat fats, and synthetic oestrogens are given to cattle as growth promoters. So if you eat meat, try to get organic sources and remember that we need much less protein than we think, as we grow older. Beans and root vegetables are also good foods; some of these may turn out to contain progesterone precursors. Look out for yams. They will not necessarily be high in diosgenin (Mexican Yam is a particular source) but they may contain some.
Nutritional supplements can also be very helpful at this time. Many women find that vitamin E reduces hot flushes, and there is also evidence that vitamin C with the bioflavonoid hesperidin can reduce them too.
GLA, found in Evening Primrose Oil and even more plentifully in Starflower Oil, provides the raw material for the body to make the protective and calming prostaglandin PGEI. PGEI can be helpful in modifying hormonal symptoms; for instance Starflower Oil can often relieve premenstrual problems. But to give your body the best chance of making PGEI you also need the vitamins and minerals used in its production. Two minerals: zinc and magnesium; and three vitamins: vitamin C, vitamin B3 (niacin) and vitamin B6 (pyridoxine, or its active form pyridoxal-5-phosphate) are needed. It also helps if your diet is low in animal fats because they can block the synthesis of PGEI.
There are also some very useful herbs. It is possible to take Mexican Yam as a herbal supplement. No one yet knows for sure what the body does with the natural sterols it contains (however, Mexican Yam has been used successfully as a contraceptive). It is possible (but unproven) that some may be converted into progesterone; some may be converted into the more ‘male’ hormones, DHEA and testosterone, that women’s bodies also make. However, these hormones are also thought to increase bone density and libido and to be helpful at the menopause.
The Chinese herbs Dong Quai, Schizandra and White Peony have been used for women’s hormonal imbalances for thousands of years and will probably be found to contain progesterone precursors, or perhaps phytoestrogens, or both. (Phytoestrogens are weak plant oestrogens that seem to be helpful. Dr. Lee believes that they bind to the oestrogen receptors in the body and block some of the effects of stronger oestrogens.) In China Ginseng is not recommended for younger women, but when a woman reaches menopausal years it is considered very good, particularly for increasing vaginal moisture and bringing back *libido.
*Ask NHM about Femme Vitalle
For taking care of your bones, you should look for a good source of calcium, (800-100mg a day including what you get from food) magnesium (300mg) and 400iu of vitamin D. The mineral boron is useful too, and since bone is fundamentally made from connective tissue vitamin C is also essential. In choosing supplements always remember that a good multivitamin/mineral formula should be your foundation to which is added the right combination formulas for your specific needs, in this case probably a good menopause supplement and a good bone-nourishing or ‘osteo’ formula.
Reprinted by permission of Positive Health Magazine.
New research suggests that crucial ingredients of HRT may not be beneficial to women after all; oestrogen could even be dangerous, says Jerome Burne. We think we know about oestrogen - the female hormone responsible for curves and smooth skin. It protects women against heart attacks but makes them more susceptible to cancer. When production drops off at menopause, oestrogen supplements can banish such undesirable side-effects as hot flushes and dry skin.
However, there is now compelling new evidence that many of the popular beliefs about oestrogen, the No.1 prescription drug in America, are wrong. ‘We will soon regard making oestrogen the key ingredient in Hormone Replacement Therapy as a major medical mistake,’ says Dr. John Lee, a family doctor from California.
He rejects the widely held belief that oestrogen protects women against heart disease. ‘The research that is always quoted is very flawed and actually shows an increase in strokes linked with oestrogen, but no one ever mentions that. Many other studies show no effect.’
Lee is equally dismissive about the value of oestrogen in treating the menopause. ‘The focus for the past 30 years has been on the drop in the oestrogen the body produces. In fact it is only about 40 per cent, enough for bodily functions, but not enough to carry a baby,’ he says. ‘Far more significant, but almost ignored, is the decline to near zero of progesterone.’ Progesterone is the neglected hero of Dr. Lee’s story. It can achieve all the benefits popularly ascribed to oestrogen, as well as protect against its cancerous effects. Lee has obtained remarkable results with natural progesterone cream. He first became interested in the subject 20 years ago when patients who could not take the usual oestrogen supplement for osteoporosis, because of a high cancer risk, responded dramatically to treatment with natural progesterone cream. In a three-year study 67 women showed 10 per cent increase in bone density followed by increases of five per cent a year until they reached full strength. The best oestrogen has done in trials is to reduce the rate of loss. But it was not only bones that improved.
‘Some women may benefit from existing HRT treatment,’ says Lee, ‘but for many it is disaster. Increasing oestrogen levels without balancing it with progesterone can produce all the features normally associated with menopause - painful breasts, fibroids, loss of libido, cravings, weight gain, depression.’ All of these problems also clear up with natural progesterone.
At which point, the medically literate will point out that modern HRT treatments include progesterone. So what is all the fuss about? They do - but crucially, they contain the artificial version, properly termed progestin.
Warnings in medical textbooks about the known side-effects of progestin illustrate just how different the two can be. Progesterone is the hormone of pregnancy, and its release is triggered by ovulation. During pregnancy, levels rise by several thousand percent. And yet progestin’s packaging warns that it can cause birth defects if given to pregnant women.
‘The problem for the drug companies,’ says Lee, ‘is that to market progesterone they have to change it slightly because you can’t patent a natural substance. That’s why progestins have different effects from the original.’
Lee also believes that the well-publicised decline in male fertility is matched by an unrecognised problem with ovulation in women.
‘The massive rise in oestrogen-like chemicals in the environment affects foetuses in ways that don’t become apparent until sexual maturity,’ he says, ‘Male fertility declines and women stop ovulating earlier than they should. But in the case of women it’s hard to spot so long as they continue menstruating.’
‘Many women in their late thirties have problems with depression, bloating and thinning bones because they are not producing any progesterone, because they aren’t ovulating.’
There is evidence that natural progesterone may reduce the cancer-promoting effect of oestrogen. A paper published last year in the journal Fertility and Sterility found that women given oestrogen had an increase in the number of pre-cancerous cells in their breasts, but that those given natural progesterone as well showed a significant reduction.
Natural progesterone can’t be taken in pill form, but in a cream it is easily absorbed through the skin. Although it is available over the counter in America and Europe, a prescription is needed here.
Dr. Shirley Bond, a Harley Street gynaecologist, talks enthusiastically about it; ‘I’ve treated menopausal problems, PMS and osteoporosis with natural progesterone and had some interesting and promising results. I think it should be part of anyone’s regime for these problems.’