Natural alternatives to hormone replacement therapy

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For most healthy women, menopause is a normal part of aging. As a biological rite of passage, it marks the transition into the post-reproductive phase of life. Menopause heralds the emergence of a new lifestyle, one of liberation from the responsibilities of the childbearing years. But it wasn’t that long ago that this transition was seen as the beginning of the end. Consider that up until the late nineteenth century, the average woman’s lifespan was only forty-nine years. Consequently, the time after menopause was short and often spent in declining health. But the longevity revolution has dramatically changed that scenario. The average lifespan has now increased to seventy-five years, meaning that in this country alone, tens of millions of women will spend at least a third of their lives after menopause. It is reasonable for these women to expect that, if they maintain salutary habits, they will be able to enjoy continued physical vitality throughout much of that time.

However, along with the potential opportunities it provides, menopause can also bring many undesirable symptoms. These include hot flashes, night sweats, heart palpitations, vaginal dryness, loss of libido, irritability, mood swings, and depression. In addition, menopause is associated with the development of several chronic diseases. As a result of decreasing production of estrogen by the ovaries, there is an accelerated loss of calcium, leading to osteoporosis and bone fractures. Lower estrogen levels also are associated with an increased risk of coronary artery disease and have been implicated in age-related memory impairment and Alzheimer’s disease.

Hormone replacement therapy

The conventional medical solution to menopause has been to narrowly define it as a deficiency syndrome that should be corrected by hormone replacement. This practice began roughly forty years ago, with the isolation of a commercial source of estrogens from the urine of pregnant horses. In 1966, the popular book Feminine Forever by Robert Wilson, M.D., touted the virtues of estrogen therapy as the answer to menopause and the “problem” of aging. Millions of women heeded Wilson’s advice. Over the next decade, Premarin, a mixture of equine estrogens, became one of the top-selling prescription drugs in the United States. The armamentarium was later expanded to include Provera (a type of progesterone) and testosterone. Various forms of these three drugs are now the mainstays of hormone replacement therapy (HRT).

Ten years after the drugs’ introduction, researchers discovered a significant downside to HRT. It was found that when estrogen was taken by women who had an intact uterus, the risk of endometrial cancer increased dramatically. After this connection was established, more than 15,000 cases of endometrial cancer were attributed to the use of unopposed estrogen during the years 1971 to 1975 alone. (This amounts to one of the largest physician-caused epidemics on record.) The risk appears to decrease significantly when progesterone is added; however, a recent study showed that the combination of estrogen and progestin (synthetic progesterone) may increase the risk of breast cancer. Estrogen should also be avoided by women with clotting disorders, migraines, gallbladder disease, hypertension, or liver cancer.

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