Why Taking Hormones in Menopause Can Improve Women’s Well-Being and Lengthen Their Lives — Without Raising the Risk of Breast Cancer.
This brilliant, groundbreaking book, co-authored by Avrum Bluming MD and Carol Tavris PhD, tackles the confusing and often controversial subject of HRT. Realizing there was so much misinformation out there, they decided to set the record straight and Estrogen Matters is the result. It is so well researched that it’s every scientist’s dream, but it’s written so that everyday folk, like me, can digest the information and feel comfort in the authors’ expertise.
The podcast episode today answers many questions women have about HRT, including its effect on heart health, breast cancer, osteoporosis and Alzheimer’s.
Dr Bluming has spent the past two decades studying the benefits and risks of hormone replacement therapy administered to women with a history of breast cancer, with over 60% of his practice devoted to treating women with breast cancer.
Carol Tavris received her PhD in social psychology from the University of Michigan. She has written numerous books, including Mistakes Were Made (But Not By Me) (with Elliot Aronson) and The Mismeasure of Woman, and she has received numerous awards for her efforts to promote gender equality, science, and skepticism.
I was delighted to have them on the show for this clear, witty and informative chat on why Estrogen Matters.
In the podcast we discuss:
- the discovery of estrogen and its role in women’s health
- the confusing terminology of HRT use
- does HRT help you live longer?
- does HRT cause breast cancer?
- the flaws that challenge the credibility of the WHI 2002 study
- why the fear that HRT is harmful persists
- what to do if your doctor says no to HRT!
History of Estrogen
Avrum Bluming (AB): Estrogen was promoted in the 1960’s as a way to keep women young forever, which was an unfair and dishonest message. A book called Feminine Forever, by Dr. Robert A. Wilson, argued that women would feel better taking estrogen “forever,” but it was promoted for all the wrong and patronizing reasons—not that it would make women healthier, but that it would keep them cute, youthful, and sexy for their husbands. Carol Tavris (CT) adds that we learned much later that Dr Wilson was in the pay of big pharma, and women’s health activists took offense to his condescending message. They associated estrogen—and that idea that women need estrogen “replacement” to be truly “feminine”—with being the villain.
AB: In the early 1970’s the popularity of using estrogen plummeted when it was found that estrogen used alone significantly increased the risk of uterine cancer, but by adding progesterone that increased risk was eliminated. When estrogen was combined with progesterone—a combination referred to as HRT or “hormone replacement therapy”—its popularity increased again. Women with a uterus are given combination HRT, but estrogen only is given to women without a uterus.
AB: By the year 2000, decades of research had repeatedly demonstrated that estrogen was found to successfully treat menopause symptoms, decrease heart disease and increase overall survival rates.
AB: 2002 saw publication of the large study from the Women’s Health Initiative (WHI), which erroneously stated that estrogen increased the risk of breast cancer, heart disease and Alzheimer’s. Almost immediately usage of HRT dropped around the world by up to 75%. By refusing to prescribe HRT, GPs thought they were helping women avoid dangerous risks.
CT: During the 1990’s critics began accusing the pharmaceutical industry of false advertising and the promotion of unnecessary or risky medications, and rejected the idea that we need to be medicated for every problem and passage in life. So by 2002 with the release of the flawed WHI study, in addition to women’s health activists arguing that women didn’t need hormones and it was unfeminist to take them, HRT was hit with a double whammy.
How was the report flawed?
CT: When the WHI 2002 report was released, claiming HRT increased the risk of breast cancer, both of us were appalled to discover on close analysis that the finding was not statistically strong or even significant. In fact, it was less significant than being a left-handed Finnish flight-attendant, or eating a piece of grapefruit every day. The finding was just not there, yet on the basis of the WHI’s claims, the study was halted and millions of women stopped taking hormones.
AB: When you test a hypothesis in science, you must be willing to show that you were wrong. In fact, science is one of the few methods we have that allow us to test our ideas by holding them up to evidence that might disconfirm what we believe. But the Women’s Health Initiative, it now seems, started out with a strong belief that estrogen is harmful and dangerous and then squeezed their data every which way they could to confirm that bias. That’s a no-no in science.
CT: Five years before beginning the study, the principal investigator of the WHI published an article calling for an end to the HRT bandwagon. And that “unbiased” man was put in charge?
Why are we fixated on the fact that HRT is harmful
CT: Fear is one of the most motivating emotions we have. Women are afraid of breast cancer because we are exposed to the idea of it – yet many don’t hear the statistics that show that 90% of women will be cured, it’s no longer a death sentence. So they seek to alleviate that fear by doing something that allows them to feel in control of their bodies, something to prevent them from getting breast cancer. In this case that would be to not take estrogen. Unfortunately, women who know that estrogen in some form makes them feel better and be healthier, will seek out pseudo-like estrogen alternatives or placebo treatments like black cohosh and gingko biloba. Despite the fact that women are told to “suck it up” in dealing with their menopause symptoms, we know that many of those symptoms—vasomotor problems such as hot flashes, insomnia, heart palpitations, brain fog,and joint and muscle pain—can take a health toll on women. They are not trivial.
AB: Women are told that symptoms last only 2 years, yet we know it is more like 7-10 years and there is nothing like estrogen to help control or eliminate the symptoms. Estrogen works in up to 85% of women.
Does estrogen cause breast cancer?
AB: The WHI study had a simple message: estrogen causes breast cancer. But actually it doesn’t. Women without a uterus who were taking estrogen alone had a 30% decrease in breast cancer. Well, the WHI said, it’s not estrogen that’s the problem but progesterone combined with estrogen that increases the risk by 26%. In fact, that’s not true either. The finding was not significant statistically, and in follow-up studies even that minor 26% vanished. Unfortunately, that news, along with other good news from the WHI—that HRT has many health benefits—didn’t make headlines.
AB: There is an argument that increased estrogen exposure in your lifetime puts you at a higher risk of breast cancer, when the opposite is true. For example, women who get pregnant before the age of 20 decrease their likelihood of breast cancer by 75%–and pregnancy increases levels of estrogen enormously. The more pregnancies a woman has, the lower her risk of breast cancer. More remarkably, women who develop breast cancer when they are pregnant do not have a worse prognosis than women who are not pregnant.
AB: We don’t understand what causes breast cancer, so we look for clues that help us deal with it efficiently. We have identified an estrogen receptor which sits on the membrane of breast cancer cells, and we know that women with estrogen receptor positive cancer respond well to hormonal manipulations, such as administration of tamoxifen or removal of the ovaries. It was assumed that estrogen always stimulates breast cancer growth, but it turns out this is not true; in fact estrogen has been used as an effective treatment for breast cancer. The belief that a woman with estrogen positive cancer cannot take estrogen has not been borne out in studies over the past 15 years.
CT: The overriding belief that estrogen is carcinogenic is what has driven so much fear. Avrum has assembled massive evidence showing that it’s time for this belief to be overturned. It’s not easy to do that once “everyone” is sure that X or Y or Z is absolutely true. It’s like the mistaken belief in the nutrition world that eating fat can make us fat. And did 40 years of all those low-fat diets do anything to reduce the obesity rate? Hardly. (When fat is removed from foods, by the way, sugar is usually added—that’s the culprit.)
Take HRT and live longer
AB: Approximately 7 times as many women will die of heart disease, in the western world, as will die of breast cancer. Estrogen has been shown to decrease the incidence of significant heart disease by up to 50%, which is why Dr Lee Goldman, a Harvard-based cardiologist, wrote a 1991 editorial entitled “Uncertainty about postmenopausal estrogen: time for action, not debate,” endorsing postmenopausal estrogen. In every decade of a woman’s life, her risk of dying of heart disease is greater than dying of breast cancer. Interestingly, the leading cause of death, even for women diagnosed with breast cancer, is heart disease, and we know that estrogen significantly reduces the risk of heart disease.
AB: Annually, about as many women die in the USA and UK due to complications from osteoporotic hip fracture as they do from breast cancer. We know that the risk of osteoporotic hip fractures decreases by 50-60% with estrogen treatment. Estrogen increases the tensile strength of the bone—its flexibility. Although women are told to take vitamin D and calcium, these supplements will not prevent hip fractures in postmenopausal women not taking estrogen.
AB: Finally, for every one person diagnosed with breast cancer, 2 women will be diagnosed with Alzheimer’s Disease—for which there is currently no treatment or cure. But studies have shown that estrogen can decrease the risk of Alzheimer’s and other dementias by 25 to 60%.
“Estrogen won’t make you feminine forever but it can make you healthier longer. “
The confusing terminology of HRT use
AB: Premarin, derived from pregnant mares’ urine, is one of the earliest forms of estrogen used. Because it has been studied for over 60 years, it appears to be the safest, and among the most effective estrogen preparations available. That evidence nonwithstanding, it is unconscionably expensive in the US.
AB: Estradiol, the most prominent circulating estrogen in a premenopausal woman, can be produced from yams. It is often sold as bioidentical estrogen, which is a marketing not a scientific term, to appeal to consumers. FDA-approved bioidentical estrogen is similar to Premarin, and is effective in dealing with osteoporosis and heart disease. It does not increase the risk of venous clots as Premarin may do. I have no problem recommending these preparations.
AB: Compounded bioidentical hormones are another matter, however. I don’t recommend them because they are produced by individual pharmacies and lack FDA regulation. Absorption of these hormones is often unpredictable. The only time that compounded drugs might be acceptable is for those women with an allergy to an approved HRT medication (such as an allergy to peanuts used in preparation of progesterone) but such cases are rare.
CT: Unfounded fear generated by the WHI left many women confused. Prescriptions for established estrogen preparations, like Premarin, plummeted. Women wanted treatment that was safe, natural and beneficial—no wonder that bogus marketers saw this as an opportunity to offer solutions. That’s why we now see the rise of menopause “boutiques” that offer “alternative treatments” that are no more than gimmicks. Most of these alternative treatments are no better than placebos, but in the absence of any regulation (or data), marketers are free to make unsubstantiated claims about their drugs and supplements.
AB: Our book has been heavily researched and referenced. And by the way, neither of us is on any pharmaceutical payrolls. We want just to get the word out about the solid research on estrogen’s benefits and associated risks.
CT: And in reviewing the research, we didn’t just “cherry pick” the studies that support our view; we were at pains to examine all studies, including those that seemed to dispute our conclusions. We have made this book, with all its lists of references, readable for a general audience. Moreover, each chapter ends with a look at possible alternative approaches—showing why estrogen remains the best intervention.
AB: We are not two strange outliers shouting in the wilderness, by the way! Our book has been endorsed by eminent physicians, researchers, and women’s health activists.
What happens when my doctor says, “NO!”
CT: North American Menopause Society (NAMS) has a menopause specialist guide –http://www.menopause.org/for-women/find-a-menopause-practitioner
AB: Genneve is an international menopause resource for women. https://genneve.com/
AB: Current Primary Care Providers have little or no training in the management of menopause, which can be challenging for women who are asking for HRT. The fact that less than 25% of OB/GYN fellowships include any education about menopause management is a national disgrace. We are trying to make as much noise as possible to change this.
CT: The first book I wrote was called The Longest War, for a reason—women have had many battles and skirmishes over the centuries on the road to becoming full citizens with the equal status of men. Whether the battle is for the vote or for reproductive rights, they have won by organizing and determining what they want for their own rights and their own health. Starting in the ‘70s with the classic book Our Bodies, Ourselves, women have demanded that the medical establishment understand that the “normal” body is not the male body. Menopause is a unique but normal phase of life for women. It’s not an illness, not a deficiency, but it can cause prolonged and unnecessary suffering and deeply troubling symptoms—symptoms that estrogen can alleviate for the great majority of women. That’s why we both believe so strongly that women must inform themselves about the benefits and risks of HRT and not just listen to the scare stories.