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CLINICAL REVIEW: Janice Rymer and Edward P Morris Extracts from "Clinical Evidence": Menopausal symptoms BMJ 2000; 321: 1516-1519 [Abstract] [Full text]

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Steroid sex hormone suppression of vasomotor symptoms

Ellen C G Grant   (4 January 2001)

Menopausal symptoms

Jean-Jacques Amy   (17 January 2001)

Steroid sex hormone suppression of vasomotor symptoms 4 January 2001
Ellen C G Grant, Physician Kingston-upon-Thames Send response to journal: Re: Steroid sex hormone suppression of vasomotor symptoms	Steroid sex hormone suppression of vasomotor symptoms EDITOR -- Rymer and Morris, who have been extensively sponsored by the manufacturers, found that vasomotor symptoms were reduced in most of the over 40 randomised controlled trials which compared oestrogen with a placebo.(1) It is not surprising that the industry would be keen to sponsor such trials as steroid suppression of symptoms has long been known. The root of the controversy is that oestrogens and progestogens can suppress vasomotor symptoms but can also increase the incidence of headaches, migraine, hypertension and strokes. Very simply, hormonal immunosuppression is accompanied by vascular and biochemical changes which can cause serious reactions in some women.(2) These changes also help to increase the risk of developing mental illness, addiction to taking hormones, and, a variety of cancers including breast, endometrial, cervical, ovarian, lung, liver and melanomas.(3) Rymer and Morris did not point out that the 51 studies they quote on the relation between breast cancer and hormone replacement therapy (HRT)(4) were not randomised controlled trials (RCT) and also had many weaknesses due to selections and exclusions. Individual studies contained major subgroups with increased relative risks varying from 1.3 to 19. (5) The increased risk of breast cancer of 21% for users of HRT, arrived at after extensive reanalysis by The Collaborative Group, is ludicrously small and does not fit with the five fold increased relative risk for women in hormone-consuming countries. Their rapidly increasing incidence of breast cancer over the last 40 years, contrasts with the much smaller increases in countries like Japan, where women have had less exposure to powerful exogenous hormones until recently. It is a failure of understanding which results in attempts to suppress vasomotor symptoms rather than remove their causes. Unmasking, recognising, and excluding the major precipitants, such as exogenous hormones, smoking, coffee, alcohol and food items like wheat and yeast can be dramatically beneficial in preventing headaches, migraine or hypertension. 2 As wheat is a common food allergen, any RCT which excludes wheat from the diet would be expected to show an improvement in vasomotor symptoms in many patients whether soya (which can also become allergenic when regularly ingested) is given or not. It is clearly foolish to treat trivial symptoms with sex hormones which are potentially thrombogenic, vasoactive, psychoactive and carcinogenic, when the symptoms can easily be prevented by other simple and safe means. Ellen CG Grant Physician Kingston-upon-Thames, Surrey KT2 7JU 1. Rymer J, Morris EP. Extracts from “Clinical Evidence”: Menopausal symptoms.BMJ 2000;7275:1516-1519. 2. Grant ECG. The Pill, hormone replacement therapy, vascular and mood over-reactivity, and mineral imbalance. J Nutr Environ Med 1998;8:105-116. 3. Grant ECG, Price EH, Steel CM. Risks of hormone replacement therapy. Lancet 1999 ; 345:1302-1303. 4. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52 705 women with breast cancer and 108 411 women without breast cancer. Lancet 1997;350: 1047-1059. 5. Price EH, Little HK, Grant ECG. Women need to be warned about dangers of hormone replacement therapy. BMJ 1997;314:376-377.
Menopausal symptoms 17 January 2001
Jean-Jacques Amy Send response to journal: Re: Menopausal symptoms	Dear Sir - In their paper on "Menopausal symptoms" Rymer and Morris (1) define erroneously the menopause as starting one year after the last mentrual period. It is on the contrary generally accepted that menopause starts immediately after the last menstrual period, as assessed one year later, during which no menstrual bleeding should have occurred. The mean age for the menopause in Britain mentioned by the authors is in accordance with the definition I just gave, and not with theirs. Jean-Jacques AMY, Professor and Head, Department of Gynaecology, Andrology and Obstetrics, Academisch Ziekenhuis - V.U.B., 1090 - Brussels, Belgium. (1) Rymer J, Morris EP. Menopausal symptoms. BMJ 2000; 321 : 1516 - 9 (16 December).