Every so often, it seems, Mother Nature has to give us a sharp reminder that medical science still has a great deal to learn about the immense complexities of the human body. The Vioxx and Celebrex tragedies are only the most recent example; Vioxx has been withdrawn from the market in the past year (and Celebrex soon to follow suit) after it was discovered that they had caused heart attacks and strokes in thousands of patients.
Once again, a silver bullet had turned to lead, in this case pain killers used by millions, particularly by arthritis sufferers. Once again, the very real benefits of pharmaceuticals had been found to entail very real risks. For millions of patients, it’s a cost-benefit trade-off with no easy choice.
There’s no better example of the dilemma than menopause (meno = menses or month, pause = cessation), the permanent ending of the menstrual cycle, which comes gradually to most women in their early fifties. Although it’s a perfectly natural change and in no sense a disease, menopause is frequently accompanied by unwelcome side effects.
By far the most common of these are hot “flashes”, a sudden inflammation of the skin of the upper chest, throat and head, accompanied by a feeling of intense body heat and sometimes profuse sweating. Although flashes eventually cease, two other much more serious effects of menopause intensify over time: the risk of heart disease and the loss of bone density (osteoporosis), increasing the risk of fractures, particularly of hip bones, in old age.
The cause and culprit here is a sharp decline, at the time of menopause, in the production of estrogen, a hormone that regulates a woman’s reproductive cycle. As long ago as the 1940s, millions of women were put on hormone replacement therapy (HRT) to make up the estrogen deficit. Synthetic estrogen, they were told, would reduce the risk of heart attacks, bone loss, hot flashes, even cancer. But then the bad news came in.
In 2002 a U.S. government study concluded that HRT actually increased the risk of heart disease and cancer in women, and that pharmaceutical companies had deliberately skewed their research findings to put a positive spin on HRT.
Which leaves women with a Catch 22: HRT unquestionably combats osteoporosis very effectively. But its risks are now undeniable. Even so, some health practitioners still have faith in HRT, and many women are still on it. Fortunately, however, there are alternatives.
Phytoestrogens (plant-based estrogens) such as soy products and the herb, black cohosh, control most menopausal effects quite well, with the added benefit of reducing the risk of both heart disease and cancer. They also combat bone loss, though probably not as effectively as HRT.
But the key here is not one line of medication or another. What all women should have is a clear understanding of menopause, accompanied by an over-arching preventative health plan and lifestyle. Given that, the vast majority of women will pass through menopause healthily and happily.
©Dr. Ashely Gordon, 2005.