It’s a generally accepted fact that women of a certain age whose sex organs are intact experience menopause. Nonetheless, the conventional medical community would have us believe that this process is something other than a natural consequence of growing older. Therefore, according to this line of thinking, the menopause process needs to be medically managed. That’s why more than six million women in this country are taking hormone replacement therapy (hrt).
However, in July, this medical management was shown to be medical mismanagement when a massive study of women on HRT was halted following the discovery that HRT was doing more harm than good. It’s impossible to disregard this news since the research is conducted by a federal agency, the National Institutes of Health (NIH) and is considered one of the largest and best-designed studies on the effects of HRT.
Besides seeking to alleviate menopausal symptoms such as hot flashes and night sweats, women take HRT as a means of preventing osteoporosis, coronary artery disease, and stroke. However, the NIH study found that women taking HRT — in this case, the hormone combination of estrogen, derived from pregnant horse urine, and progestin, a synthetic HRT form of progesterone — had a greater risk of breast cancer, heart attack, stroke, and blood clots.
Integrative medical doctors such as Chicago internist David Edelberg find it significant that these health complications come from using the synthetic HRT form of progesterone and the equine form of estrogen. The molecular structures of these hormones, he says, make them inappropriate for use by humans. Dr. Edelberg uses natural HRT vegetable-derived hormones when he believes that a woman’s condition warrants it. Nonetheless, the horse-derived hormone, Premarin is one of the most prescribed drugs in America, generating two billion dollars in sales last year for its maker, Wyeth.
Dr. Edelberg, the medical director of Whole Health Chicago, a holistic medical clinic, has strong opinions as to why the synthetic progesterone and horse-derived estrogen are used so pervasively in the United States and points an accusing finger at pharmaceutical companies and their influence over doctors. "If pharmaceutical companies have a product they’re trying to sell to physicians [such as HRT], they convey to the physicians that they are dealing with a disease because physicians can relate to that. Doctors are used to writing prescriptions for diseases...but it’s not a disease, it’s a transition!"
Pharmacist Pat Frieders, co-owner of The Compounder, a specialty drug store in Aurora, Illinois, echoes Dr. Edelberg’s analysis. She specializes in preparing — or compounding — custom medications for patients. In particular, she compounds formulas of natural — or what’s termed bio-equivalent — hormones for women. Bio-equivalent means that the molecular structure of the hormone is recognized by the body as the identical substance it produces itself. These are the hormone forms that integrative doctors like Dr. Edelberg use instead of the conventional HRT, which Frieders says is not bio-equivalent.
But Frieders says even though the natural hormones are preferable, they are not products that will make money for pharmaceutical companies. "It’s our belief that the reason drug companies push the conventional HRT rather than just offer natural progesterone or estrogen is because they can’t make any money on them," laments Frieders. "They’re natural products and can’t be patented. So therefore, they have to find something of their own that they can develop and patent."
Premarin is a prime example of a proprietary hormone product. The pharmaceutical company, Wyeth, makes Premarin by using a patented process that extracts estrogen from the urine of pregnant horses. Besides rejecting the use of Premarin for his patients, Dr. Edelberg is outraged by the procedure that produces Premarin, which consigns pregnant horses to a life of living agony. "At any given moment," he says, "approximately a hundred thousand horses are in tiny stalls with a catheter in their bladders and can barely move around. They are kept in a state of constant dehydration in order to produce concentrated urine. They are impregnated artificially, carrying the foal while the urine is collected throughout the pregnancy. When the foal is delivered, it’s taken and ground up for dog food. When the mare dies, she is ground up for dog food."
Beyond the cruelty of this method, Dr. Edelberg ponders the negative energies that arise from it. "People who are into alternative medicine understand the concept of subtle energies like chi, vital force, and so on," he says. "When you tell someone a story like this who knows subtle energies they think‘Oh my God, the negative energy of each [Premarin] capsule! No wonder it promotes cancer!’ Of course, that kind of logic to a conventional physician would cause eye-rolling to the ceiling."
As an internist, Dr. Edelberg sees one or two women a day who are struggling with menopausal symptoms that can range from mild to quite severe. He advises women who are experiencing mild-to-moderate symptoms — such as night sweats, disturbed sleep and hot flashes — to begin using progesterone cream, to add herbs such as black cohosh, and increase their soy intake. All of these are natural approaches that have been shown in studies to alleviate menopausal symptoms.
Dr. Edelberg prescribes the natural hormones for those women who have severe menopausal symptoms. "Natural hormones are really women’s hormones derived from soy. The soy is processed to produce a molecule that is simply identical to the three estrogens that the women’s ovaries produce...and that’s why they’re called natural. I haven’t written a prescription for conventional HRT in years. I would never put a woman on those; I wouldn’t put a lab animal on those!"
Pharmacist Frieders contrasts conventional HRT and natural hormone replacement as the difference between using a potent drug and something the body fully accepts as natural. "In a sense, when you take natural hormones you’re really just supplementing with identical things that your body used to make but no longer does," she says. "It’s similar to how we supplement with vitamins and such. We figure when we’re deficient in something, we supplement. It’s the same type of principle when you use natural hormones. You’re just supplementing what’s low versus giving a drug such as conventional HRT, which somewhat mimics the effects but has a whole host of side effects of its own."
Dr. Edelberg says there’s no reason a woman needs to be on conventional HRT. "What did your grandmother do, for heaven’s sakes? You can deal with menopause symptoms on your own. In the United States if an American woman avoids junk food, eats a healthful diet, exercises regularly, and adds plenty of soy to her diet, she’ll probably avoid menopausal symptoms."
He also adds that there’s no reason for a woman to take the hormones for disease prevention. If she’s living a healthy lifestyle, Dr. Edelberg says, she’ll likely avoid heart disease. If she’s worried about bone loss leading to osteoporosis, then he advises taking vitamin and mineral supplements to avoid the problem.
Disclaimer: This column is for information only and no part of its contents should be construed as medical advice, diagnosis, recommendation or endorsement by Ms. Ephraim.
Rebecca Ephraim is a registered dietitian, certified clinical nutritionist and a nutrition reporter specializing in integrative medicine issues.
© Rebecca Ephraim. All rights reserved.