Transcribed from Dr Lee’s Medical Letter by kind permission of the author.
THE JOHN LEE MEDICAL LETTER
July 2002
Last month I received an e-mail from a woman who had read one of my books and as a result had gone to her doctor and asked to be taken off of Prem Pro and put on natural hormones. His response was, “Now why in the world would you want to do that?” When she tried to explain he interrupted her, ended the visit, and left her with another prescription for PremPro. Since then, as most of you know, there have been two major studies published showing that conventional hormone replacement therapy (HRT or ERT) does more harm than good. This woman, and millions like her, deserve an apology at the very least.
The first study published is from the huge Women’s Health Initiative (WHI), a portion of which was ended after five years (three years early) because of a clearly greater risk of invasive breast cancer, heart disease and strokes among women using PremPro [Premarin (equine oestrogens) plus Provera (a synthetic progestin)].
The second study is from the breast Cancer Detection Demonstration Project, part of a nation-wide breast cancer screening program, and it showed that oestrogen-only hormone replacement (ERT) increases the overall risk of ovarian cancer by more that 3-fold. Given what we’ve known for at least twenty years about unopposed oestrogen’s cancer-promoting properties on a woman’s reproductive system, the concept of giving only oestrogen to women without a uterus should never have taken hold in medical practice in the first place.
I’ll go into the WHI study in more detail shortly, but first I’d like to put these studies into a broader perspective: conventional medicine needs to change its attitudes towards women, and it needs to disentangle itself from the big drug companies.
WHAT WE ALREADY KNEW
It’s been evident for over a decade that HRT is only marginally effective for treating osteoporosis, and that it causes heart disease, breast cancer and strokes. I wrote about this in my first self-published book about progesterone in 1093. Why has it taken conventional medicine so long to catch up to the obvious? Drug company money and politics, what else? The two studies mentioned above were so large that the evidence could no longer be ignored, but in the meantime tens of thousands of women have been killed or permanently harmed by taking HRT. Conventional medicine, which trumpets that it is “evidenced-based,” allowed millions of women to be given HRT without evidence that it was safe or effective.
The practice of medicine in America has been hijacked by big drug companies, who control everything from education, to continuing education credits, to which studies are published in our largest medical journals. Let’s get real here: drug companies are in the business to make money, not to heal people. It’s the job of medicine to heal, and to the extent that American medicine allows itself to be controlled by drug companies it is not about healing, and is needlessly harming millions of people every year.
And then there are the antiquated medical attitudes towards women. About a month ago there was an article in the New York Times about perimenopause (the years just before and after menopause). It began with the fact that Oprah had done a show on perimenopause symptoms with Dr Christine Northrup, and had received so many e-mails afterwards that her website server had crashed. In other words, thousands of women could relate strongly enough to the information presented that they felt inspired to send an e-mail to Oprah. For every woman who sent in an e-mail, there were undoubtedly many others who felt the same way. And yet, the rest of the Times article focused on quoting doctors who belittled the concept of perimenopause symptoms and claimed they don’t exist. The implication is that all those women were just making up their problems. This is a perfect example of how conventional medicine treats women with an attitude that says, “We know better than you do what you’re experiencing and if it doesn’t fit the picture, it’s all in your head, and we’ll anaesthetise you emotionally with antidepressants, or tranquillise you with anti-anxiety drugs.”
The same type of mistreatment has occurred with millions of women over the past two decades who have been put on conventional HRT, complained to their doctors about side effects such as weight gain, anxiety and insomnia, been told it’s all in their heads, and given anti-depressants such as Prozac or anti-anxiety drugs such as Xanax. Little did they know they were also being given heart disease, cancer and strokes.
It’s likely that American doctors as a group are feeling somewhat chagrined that they’ve been handing out HRT like candy, only to find out that it can be deadly and wasn’t even effective anyway (except for controlling hot flushes and night sweats). However, their response in the media had not been encouraging. In the past two weeks I have read or heard doctors in the media claim that,
“…It’s only 8 out of 1,000 women who are affected, which is a very small number,” (The 40,000 women who have died or been seriously harmed in the past decade by HRT, and their families, may not agree.);
And “…it’s still fine to use HRT on a short-term basis,” (Do these doctors believe that cancer just suddenly appears one day out of the blue? It takes breast cancer years to develop into a noticeable mass.);
and “…there are no alternatives to HRT that work,” (Clearly they haven’t tried any alternatives.).
I know that to long-time readers of my books and newsletters this may be repetitive, but it needs to be said over and over: women need to take their health into their own hands; they need to trust their intuition about what is right for them; and they need to assertively insist that their doctors listen to them. The good news is that a door has been opened for women to bring information about natural hormones to their doctors. For many doctors, it’s going to take a lot of courage to admit they’ve been misinformed, but they can make up for the harm they’ve done by opening their minds to other possibilities and looking outside the drug company standard of care for answers. Some doctors are going to be defensive and never shift gears, but many will now be open to learning about natural hormones.
GETTING OFF HRT AND ONTO NATURAL HORMONE
You can have balanced hormones, and relief from menopausal symptoms, without using conventional HRT.
A portion of the women’s Health Initiative (WHI) study was cancelled because of a high risk of breast cancer, heart disease and stroke associated with using conventional combined HRT (hormone replacement therapy). The study analysed the health of 16,000 women aged 50 to 79 years. After five years, those using conventional combined HRT (Premarin and Provera, aka PremPro) had a 29 percent higher risk of breast cancer, 26 percent higher risk of heart disease, and a 41 percent higher risk of stroke.
To personalise these numbers a bit more, of the 6 million women who are using PremPro (this is a very conservative estimate and doesn’t count the millions of women on other combinations of HRT), this translates to approximately 4.200 women who got breast cancer, 4,800 women who got heart disease, and 10,800 women who had a stroke in a five-year period because they were taking this form of HRT. If we extend these numbers out over a decade, nearly 40,000 women were harmed (many of them killed) by taking these drugs. That’s an epidemic, and doesn’t include all the women who suffered from weight gain, fatigue, depression, irritability, headaches, insomnia, bloating, low thyroid, low libido, and gallbladder disease and blood clots.
One of the most disturbing aspects of this scenario is that it was created due to the carelessness of conventional medical practice, which dictated – without good supporting evidence of safety and efficacy – that any woman over 50 complaining about anything remotely related to menopause be put on HRT. Their hormones weren’t measured to find out which ones they needed or how much, and they were subjected to a one-dose-fits-all mindset that created overdose of oestrogen for millions of women. Furthermore, the efficacy of progesterone in hormone replacement has been totally ignored in favour of the patentable (and more profitable) synthetic counterparts known as progestins.
To readers of my books and newsletters, the risks and side effects of conventional HRT are not news – the evidence of harm has been showing up in research for at least a decade. This particular study was finally large and prestigious enough that conventional medicine was forced to pay attention.
Q & A ON NATURAL HORMONE REPLACEMENT THERAPY
The following Q&A will give you an overview of the issues and answers surrounding conventional medical HRT versus natural HRT. For details, please refer to the interview with Dr Randolph at the end of this article as well as Dr John Lee’s What Your Doctor may not tell You… books. many back issues of this newsletter have also covered these questions in detail. You’ll find a comprehensive index to back issues of the newsletter on my website in the Quick Index (www.johnlee.com).
Q: Do the results of the WHI apply to your recommendations for using natural oestrogen and progesterone?
A: Not at all. What I recommend is first measuring saliva hormone levels to find if there is a hormonal imbalance. Then, if necessary, correcting the imbalance using natural hormones in physiologic doses, which means ordinary doses that the body would naturally produce itself. (Please read any one of our books for details.)
Another way to look at this is, from puberty until menopause, a healthy woman’s body is making its own natural hormones in synchrony and balance, without giving her cancer, heart disease or strokes. What I recommend is attempting to regain this natural balance as closely as possible.
Conventional HRT not only fails to measure hormones and use physiologic doses, it uses synthetic not-found-in-nature “hormones” that are foreign to the human body and cause a long list of unwanted and dangerous side effects.
Q: How do I get off PremPro?
A: Most women simply need to lower their dose of oestrogen and replace the progestin (the “pro” part of the PremPro) with progesterone cream.
Oestrogen is a prescription-only medication in the U.S., so you’ll need to ask your doctor for a separate prescription for oestrogen, preferably either oestradiol, or a combination of oestradiol and oestriol, or oestriol alone (please read our breast cancer book for details on using oestriol). Even Premarin, although ethically objectionable in the way it is obtained from pregnant mares, will work if it is used in the lowest dose needed, and in combination with natural progesterone. If you discontinue oestrogen suddenly, you’re likely to suffer from hot flushes and night sweats. Hot flushes and night sweats are less likely if the oestrogen dose is decreased in gradual steps.
Unless your doctor already has you on another form of HRT with a low dose of oestrogen (0.5 mg for example), you can begin with half the dose you have been taking when you add progesterone cream in place of progestin. Many menopausal women don’t need any oestrogen at all, and can gradually taper (over 3 to 4 months) their dose down to nothing.
Although transdermal progesterone alone will alleviate menopausal symptoms for many women, still, some women may need a little bit of oestrogen to control their symptoms. Symptoms of oestrogen deficiency include hot flushes, night sweats and vaginal dryness.
Q: My doctor says that I can’t use oestrogen and progesterone cream, because progesterone cream won’t protect my uterus the way the progestins do.
A: Progesterone cream protects the uterus just fine. Not only did I not have any problems in my hundreds of menopausal patients before I retired from practise, I am in touch with dozens of physicians who have thousands of patients among them, who have never had a problem (some of them have been doing this for over a decade). Furthermore, a soon-to-be published double blind, placebo-controlled study by Helene Leonetti, M.D., proves that progesterone cream protects just fine. Her study compared the uterine protection of PremPro with an oestrogen/progesterone combination. In short, the women on the progesterone cream came out just fine.
You might also ask your doctor how he thinks that your premenopausal body protected itself against oestrogen effects. It was the progesterone that your ovaries made every month!
Q: My doctor Says that because blood tests don’t show a rise in progesterone when progesterone cream is used, that it doesn’t work, and I should use oral progesterone.
A: Blood tests only measure the serum, which is the watery part of the blood, and progesterone absorbed from a cream is carried in the red blood cells, not in the serum. The most accurate way to measure hormone levels is with a saliva hormone level test, which measures your active or bioavailable hormones. When you use progesterone cream, a saliva hormone test will show a gradual rise in hormone over a three-to four-hour period, then it reaches a plateau for several hours, and then it gradually drops such that 90 percent is gone after 15 hours. This amount of time is an average, and can vary a bit from woman to woman.
Q: I read an article in a major magazine where a doctor is quoted as saying that natural progesterone stimulates tissue growth in the breast and therefore could contribute to breast cancer. Is this true?
A: We have tracked down the source of this information, and once again, it was a progestin, not progesterone, that stimulated the cell growth in the study being referred to. As you’ll read in our books, progesterone stimulates cells to grow toward differentiation, which is an anti-cancer property. Cancer cells are undifferentiated, and thus grow without control. Progesterone also encourages cells to die when they’re supposed to (which cancer cells don’t do). This topic is covered in detail in What Your Doctor May Not Tell You About Breast Cancer.
Take care until next month.