Kitabı oku: «Hormone Replacement: How to Balance Your Hormones Naturally»
Copyright
Thorsons
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This Thorsons edition published 2004
First published 2002 by WHAS Pty Ltd.
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Email – cabot@ozemail.com.au
www.liverdoctor.com
Copyright © Sandra Cabot 2002, 2004
Sandra Cabot asserts the moral right to be identified as the author of this work
Cartoons by Karen Barboutis
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Source ISBN: 9780007178971
Ebook Edition © JUNE 2014 ISBN: 9780008104641
Version: 2014-07-31
Disclaimer
The suggestions, ideas and treatments described in this book must not replace the care and direct supervision of a trained healthcare professional. All problems and concerns regarding your health require medical supervision by a medical doctor. If you have any pre-existing medical disorders, you must consult your own doctor before following the suggestions in this book. If you are taking any prescribed medications, you should check with your own doctor before using the recommendations in this book.
Dedication
This book is dedicated to all the wonderful women on the planet who deserve to enjoy their golden years in a civilized way.
Contents
Cover
Title Page
Copyright
Disclaimer
Dedication
Introduction: My Perspective on Arriving at the Menopause
Chapter 1 The History of HRT
Chapter 2 The Menopause
Chapter 3 Hormonal Imbalances
Chapter 4 Testing for Hormonal Imbalances
Chapter 5 The Ins and Outs of Natural HRT
Chapter 6 What Are the Super Hormones?
Chapter 7 Can Hormones Help Your Sex Life?
Chapter 8 Weight Control During and After the Menopause
Chapter 9 Body Types and HRT
Chapter 10 The Menopause and Your Appearance
Chapter 11 Special Circumstances at the Menopause
Chapter 12 How to Deal with the Side-effects of HRT
Chapter 13 How Can I Reduce the Risk of Osteoporosis?
Chapter 14 Depression and Anxiety During the Menopause
Chapter 15 How Can I Reduce the Pain of Fibromyalgia?
Chapter 16 Premature Menopause
Chapter 17 HRT – Should I Take It?
Chapter 18 Nutritional and Herbal Medicine for the Menopause
Chapter 19 Relief of Menopausal Symptoms
Chapter 20 Prescription Hormones – Natural and Synthetic
Farewell
Resources for Women with Hormonal Problems
References and Bibliography
Glossary
Fitness and Exercise
Reference Values of Hormone Levels in Saliva Samples
About the Author
About the Publisher
Introduction:
My Perspective on Arriving at the Menopause
When I was a young woman, I considered women of 40 to be old, and I related best to women of my own age group. I enjoyed delivering babies and dealing with gynaecological problems, and considered helping women to go through the menopause to be less of a challenge.
I never looked forward to getting older, and I associated the process of ageing with a loss of power and vitality. As a child I related to Peter Pan – he could fly anywhere and had magic powers. Peter Pan never got old, and neither would I!
When I turned 50, I found that my concepts of ageing were wrong. The day of my 50th birthday I woke up and said to myself, ‘Wow! I feel so powerful and energized.’ I had so much knowledge to give and share, and I felt inspired to go out into the world and be myself. I felt as though the creative force that keeps me alive and breathing – whether you call it God or the divine force – had entered my being and given me a new sense of direction. I was grateful for this and felt it to be a special gift. This experience happened within me, and was not dependent upon my life circumstances.
A woman of 50 has lived life and has understood so much that a younger woman has yet to know. Perhaps the milestone of 50 is a sacred rite or passage that needs to be celebrated. By this age we have become women of substance, no longer frightened to show their stuff to the world. Sure, we may have flagging hormones, a few wrinkles on our face, a few spare tyres around our abdomen and a few bones that ache, but wow we have a mind that has become a treasure-house of knowledge and understanding. Yes, we are truly fortunate to be able to live as long as 50, as not all of our sisters get to live this long. I consider that every year I live beyond 50 will be a bonus.
Yes, it is good to be wise and happy when we get to menopause; we deserve this – it is not hard to achieve, as this experience lies within us all – it is a gift and is our divine right.
Now I have arrived at 50, I am complete and fulfilled, proud of my achievements, and I hope to be a humble servant of the greater power that sustains us all. I have come to understand that –
My health is my greatest asset.
I can be happy in myself, irrespective of my relationships.
I can live my life as an expression of myself, and not justify it to others.
I can find love and fulfilment in sharing and helping others.
All the love that I need is found within me, and I do not need to rely on another person to make me happy.
I can have a fulfilling and interesting relationship with my own mind and I do not have to be bored.
I can continue to learn and grow and become a better person.
I do not have to worry, and I am taken care of by something much greater than my own concerns.
There are many philosophies and ideologies, but the soul can only be quenched by love.
I will always be beautiful, although my body will age.
I will always be young in the eyes of our creator, and I can always experience the excitement and adventure of a child.
I value my friends and team of helpers who help me achieve my goals.
I can always believe in my dreams, as only this will make them happen.
Although I need to listen to others, I can trust my own intuition.
I have a unique experience of life that is so special, and so do you – as women we need to stand together and help all our sisters achieve their true potential. It’s called woman power and it’s great! As they say, ‘I don’t suffer with hot flushes, I have power surges!’
When we share the truth, we do not have to be academic or intellectual; the truth is the truth – it is honest, makes sense, and is beautifully simple.
Welcome to the truth about HRT and the experience of the menopause!
It Is Time for a Totally New Approach.
I believe it is time for a totally new and truthful perspective on the menopause. Currently women are confused and are uncertain about what they can or should do about their flagging hormones as they become older. I have helped literally thousands of women go through the menopause over the last 25 years, and I have witnessed many different types of Hormone Replacement Therapy (HRT) come and go. I have been through my own menopause, and you could say I have been through the menopause thousands of times, along with my patients, while trying to help them!
I have used many types of HRT with great success, and I have found that HRT can have a dramatically beneficial result in many women. Different forms of HRT can alleviate the horror of postnatal depression, overcome premenstrual mood disorders, and rejuvenate the sex life of older women. Indeed, I have found that ‘hormones make the world go round!’ Many of my patients wish to continue with HRT in some form, and come to see me to find out how they can continue to use hormones in a safe, natural way. Many of them are very unhappy about the prospect of completely giving up any form of HRT.
One of the reasons why women are so confused is that there is now so much conflicting information about the pros and cons of different types of HRT; indeed, many women feel that they have too much information to sort through. There are books that tell us that we should avoid ALL types of hormones and rely exclusively upon herbal treatments. There are other books that tell us that all women need ONLY ONE hormone, called progesterone, and that all the other hormones available are unimportant, dangerous or will create imbalances.
None of these theories is strictly correct, because every woman is a unique individual and needs her own tailor-made program to help her through the hormonal upheaval of the menopause and ageing. Some women will find that natural progesterone by itself is totally inadequate; other women will find that herbal formulas alone do not have an adequate effect.
When it comes to hormones, we must always rely on science and safe proven medical practices; however, there is also the art of prescribing HRT, which takes years for a health professional to perfect. All the body’s hormones need to be correctly balanced and fine-tuned like the instruments in an orchestra, to enhance the emotional, physical and sexual quality of our lives.
Some Thoughts at the Menopause
I have some lines in my face from fifty years of life.
They tell me of years in the sun, of sorrows and joys.
They tell me of time.
They tell me I have lived and that I am still alive.
They can’t be erased. They can be softened…
Do I long for the smooth-skinned, freckle-faced kid I once was?
No. I long for the same thing today that I longed for then: to be the best I am able to be.
Taken from Kaylan Pickford, Always a Woman (NY: Bantam Books, 1982)
Chapter 1
The History of HRT
Over the years there have been many different studies and clinical trials examining HRT. Some have shown that HRT protects against cardiovascular disease, while others have shown that it increases the incidence of blood clots. Some studies have shown that long-term oestrogen, by itself, increases the risk of breast and uterine cancer, and we now know that combined oestrogen and progestin tablets given for over three years also increase the risk of breast cancer.
Major HRT Studies: A Summary
1975 – The New England Journal of Medicine published the results of two major studies that showed that oestrogen given alone (without progestogens) increased the risk of uterine (endometrial) cancer.
1985 – The US Nurse’s Health Study involving 120,000 women found that oestrogen replacement in post-menopausal women reduced the risk of heart disease.
1995 – The US Nurse’s Health Study found that oestrogen increased the risk of breast cancer.
1997 – The Collaborative Group on Hormonal Factors in Breast Cancer found that women on HRT have a three times higher risk of blood clots.
2000 – The National Cancer Institute study found a 40 per cent increase in the risk of breast cancer in women on combined HRT.
2002 – The US Women’s Health Initiative (WHI) Study showed that combined oral HRT increased the risk of blood clots, stroke, cardiovascular disease and breast cancer.
In the 1970s we found that oestrogen given alone increased the risk of uterine cancer, so we then added synthetic progestogens to the oestrogen, to stop this danger. However, in avoiding HRT-induced uterine cancer, we then induced even more dangers – namely an increased risk of breast cancer, cardiovascular disease and blood clots. In other words, by trying to prevent one type of cancer, we have introduced a range of different, unexpected problems. The results of the WHI Study show definitively that when synthetic HRT interferes with the balance of the body’s natural hormones, we can expect adverse effects in a significant number of women.
Oral Combined HRT – No Longer the Gold Standard
Oral combined HRT generally consists of tablets containing natural or equine oestrogens, combined with a synthetic progestogen.
The vast majority of the long-term studies of HRT have been done using hormone tablets, most of them using equine-derived oestrogens and synthetic progestogens. These studies have not examined the long-term risks of natural hormones that are absorbed through the skin, such as gels, creams and patches. Absorption of hormones through the skin is called transdermal absorption, as opposed to oral absorption.
Hormones applied to the skin do not pass through the liver immediately after absorption. There is a huge difference in the metabolic effects of oral hormones compared to hormones that are absorbed through the skin (transdermally).
One of the major reasons that large long-term studies on natural HRT absorbed through the skin have not been done by drug companies is that it is not possible to patent a truly natural hormone. Thus there is no financial incentive for drug companies to do these very expensive studies, as they would never recoup their costs.
Personally I have never felt comfortable prescribing hormone tablets for the long-term treatment of menopausal symptoms. This is because hormone tablets must be broken down by the liver immediately after their absorption from the gut, and thus will exert metabolic changes in the liver. These metabolic changes can increase the production of proteins, including clotting factor proteins by the liver, and this is why HRT given orally will increase the risk of blood clots.
I have also found that oral HRT will cause weight-gain in many women, and that is because it increases the workload of the liver. The healthy liver is the major fat-burning organ in the body; if you increase its workload, there will be less metabolic energy left within the liver cells to burn fat.
Oral combined HRT can increase the incidence of migraines, high blood pressure, high cholesterol, fluid retention and liver and gall bladder problems, once again because of its adverse effect upon liver function.
How It All Started
Many women are now feeling confused, and no doubt somewhat abandoned, as they learn of new controversies about the hormone tablets they take, which drug companies once promised could protect their bones and hearts from the ravages of time.
Well, let’s face it, hormone replacement therapy is nothing new, and has always been controversial, and either in or out of fashion.
Way back in 1889, Professor Charles Edouard Brown-Sequard announced to the French Academy of Sciences that he had injected himself with testicle juice extracted from the pulverized testicles of guinea pigs. He proudly stated that this testicle juice produced a miraculous rejuvenation in his body! At the time of injecting himself he was 72 years old, and his state of physical exhaustion had led him to experiment with a hormonal treatment. He said that, ‘Before I gave myself these injections, I could not work for more than half an hour in the laboratory without having to sit down; even when I was sitting down I felt exhausted after three hours of work. By the third day after starting these injections, all that was changed, and I had recovered my former vigour. I can now without effort or even thinking about it, run up and down the stairs – as I used to do, up to my 60th birthday. After the first two injections, my forearm showed an increase of 6 or 7 kilograms over its previous strength.’
Professor Brown-Sequard was talking about the powerful rejuvenating effect of the hormone testosterone, which was present in abundant amounts in the guinea pigs’ testicles. He also obtained excellent results after injecting ovary juice into women. The Medical Record of 20 June 1889 acknowledged that Brown-Sequard’s discovery was brilliant, if incomplete. Although he was controversial, in many ways he advanced the speciality of hormones, known as endocrinology, and he was a great researcher.
Progesterone was isolated and collected from the ovaries of pigs, and from human placentas, in the early 1930s. In 1938 natural progesterone was first synthesized from the plant hormone diosgenin, by an American biochemist named Russell Marker.
In the 1940s natural forms of HRT were developed mainly by Schering Pharmaceuticals in Germany, and injections containing natural oestrogen, progesterone and testosterone became popular.
Oestrogen therapy first became famous in 1966, when American doctor Dr Robert Wilson, released his best-selling book Feminine Forever, which promoted oestrogen as the elixir of youth. To Dr Wilson, his discovery that oestrogen was able to rejuvenate women’s lives was just as momentous as the replacement of insulin in people with diabetes, who could no longer make insulin themselves. In The Journal of the American Geriatric Society in 1972, Dr Wilson wrote, ‘Breasts and genital organs will not shrivel, and women will be much more pleasant to live with, and will not become dull and unattractive.’ I do not think that Dr Wilson’s comments would be popular with modern-day women – they are decidedly sexist and ageist!
Professor Brown-Sequard and Dr Wilson were correct – hormones are powerful rejuvenators with anti-ageing effects, and many people have had their lives dramatically improved by the use of natural HRT.
Changing Attitudes
Compared to 100 years ago, women now have a much longer life span, and go through the menopause at a relatively young age. This begs the question – ‘Is it really natural to load up every post-menopausal woman’s body with high doses of synthetic hormones for the last 20 to 30 years of her life, just to prevent chronic diseases that may never happen?’
I think to do so is an over-reaction to a normal phase of a woman’s life. You could say this approach is not natural nor physiological, and yet during the past 20 years we have come to see this practice as acceptable and even desirable. I think this idea originated in the mid-1980s when the ‘medicalization of the menopause’ was first promoted. This concept generated fear that women must do something drastic to overcome the ‘disease of the menopause’. In 1985, a special supplement in The Medical Journal of Australia stated that, ‘The post-menopausal climacteric should be regarded as a sex-linked, female dominant, endocrine deficiency disease, with specific symptoms and signs, which should be investigated and managed in a very careful and considered fashion, for the remainder of the woman’s life.’ This concept was promoted to the medical profession, so that doctors started to see the menopause as a disease state, for which they should prescribe therapy. Thus the idea of the menopause as a disease to be feared was passed on to women by their doctors and the media. Women’s attitude towards their own menopause started to change, so that they no longer saw it as a natural phase of their lives. This imposed attitude was a barrier to women seeking to get in touch with their own feelings and reactions towards the menopause. They started to see hot flushes as a symptom of disease, and the term ‘the change’ became synonymous with the beginning of a downward spiral. This atmosphere of fear made many women feel that without dependence upon long-term medicines, their own actions could not have a significant impact on their future health. Thus the mid-1980s was a time of disempowerment for older women. They were mistakenly led to believe that the prevention of the diseases of ageing – namely heart disease and osteoporosis – could only be successfully controlled by HRT, and not with self-help measures such as a healthy diet and lifestyle.
All women were put into the same ‘herd mentality’, and the concept of treating all menopausal women the same was created; in other words, ‘one-brand one-dose of HRT’ was thought to fit all women. The concept of ‘super-market-brand-name-HRT’ became entrenched, and the last 30 years of a woman’s life was now a lucrative commodity.
I was never impressed with this concept, as I could see that many of my patients were unsuited to oral synthetic hormones. My suspicions about oral HRT were confirmed when, as a young doctor in the 1970s, I visited the retirement haven of Miami Beach in the US. During the 1970s, the Premarin brand of oestrogen was the fifth-biggest-selling prescription drug in the US. In Miami Beach I observed thousands of older women enjoying their golden years who had been, or were taking, the fashionable HRT. However, these women did not look healthy – their skins were wrinkled and their postures stooped, and they lacked vitality. Unfortunately the elixir of synthetic hormones could not undo the damage from years of inactivity, smoking and consuming refined processed foods. Interestingly, during the 1980s when I worked in a missionary hospital in northern India, the older women looked much stronger and more youthful than those in Miami Beach, despite a life of hard work, no HRT and nutritional restrictions.
During the 1990s, HRT continued to increase in popularity, and in the year 2000, 46 million prescriptions were written for Premarin (equine oestrogens), making it the second most frequently prescribed medication in the United States, accounting for more than $1 billion in sales, and 22.3 million prescriptions were written for Prempro (Premarin plus Provera). The US Food and Drug Administration approved this type of HRT for the relief of menopausal symptoms and the prevention of osteoporosis, and long-term use of HRT became fashionable to prevent a range of chronic diseases, especially heart disease.
Women Want Choices
All of the millions of women out there who have been happily taking oral combined HRT now find themselves in a dilemma. Many feel they have been misled or abandoned, however the current situation is a reflection of the fact that research takes many years to give us long-term results. Well, we do not want to be research guinea pigs! Now is the time for women to stick together and explore the safest and most natural options. Yes, it is a time where common sense and instincts should prevail, and luckily you do not have to be a rocket scientist to see that there is a world of difference between the different types of HRT now available. Indeed, you do not even have to be a doctor!
This book will take away the fear and confusion surrounding HRT and the menopause, and bring you right up to date. There is no doubt that certain types of HRT can help to slow down the ageing process and improve the quality of your physical, mental and sexual life.
There is no need to give up all hope; some forms of HRT may be able to help you, with minimal risk involved. In other words, you don’t have to throw the baby out with the bath water!
Very few things in life are risk free or come with a 100 per cent guarantee, so let’s get real! We all take a calculated risk every time we drive a car, play sports or, indeed, leave the house. You can even get robbed while you are still at home, and you can never indemnify your life completely. Most of us want to live life to the full and feel challenged, stimulated and sensual, so we take calculated risks every day.
If we can relieve the unpleasant symptoms of the menopause and ageing with effective treatments that do not expose us to unacceptable risks, then we have achieved the best possible compromise. By understanding the ways that natural HRT can be given without upsetting the body’s natural equilibrium, we increase our choices of strategies that will safely improve the quality of our lives.
Some women will not need any HRT, and will need instead a good diet and healthy lifestyle. Other women will find that the menopause and ageing process produce undesirable and/or painful changes in their body and mind, which can only be relieved with some form of natural HRT.
Thankfully, the menopause is no longer ‘the change of life’ that is to be feared. I often reflect upon just how difficult it must have been for women who lived in the early 1900s to cope with these unpleasant symptoms. They must have been very strong women indeed, but strength alone cannot get you through severe hot flushes, insomnia, a desolate sex life, fibromyalgia or a severe emotional imbalance. These women had no choices – no HRT, no anti-depressant medications and probably very little understanding from society, the medical profession or their families.
Today, women have vastly different expectations of life, and do not want to suffer unnecessarily with unpleasant symptoms. They do not want osteoporosis, rapid ageing or an unsatisfying sex life.
Since the 1940s, HRT has gone through many trends, fashions and different types of packaging. We now have so many ways of putting hormones into your body that it is quite incredible! This ranges from hormone tablets, implants, injections, pessaries, vaginal rings, patches, creams, gels, sprays and lozenges (troches). Among all these possible ways of taking HRT, it is now possible to find a safe tailor-made programme of HRT to suit every woman who wants to take HRT.
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