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Flawed advice from HRT specialists
- Ellen CG Grant (19 October 2003)
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Effect of HRT on mood change
- Elizabeth H Price (8 November 2003)
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HRT
- Elizabeth J Hallworth (31 May 2007)
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Ellen CG Grant, Physcian and Medical Gynaecologist 20 Coombe Ridings, Kingston-upon-Thames, Surrey, KT2 7JU, UK
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EDITOR--The consensus statement of the hormone replacement therapy (HRT) specialists, attending a pharmaceutical industry sponsored conference in Edinburgh, underestimates the dangers of HRT.1 Progestogen/oestrogen combination usage increased excess cases of breast cancer from 6 per 1000 women for 5 years of use to 18 per 1000 women for 7 years of use in the Women’s Health Initiative study (WHI).2 There was a similar three-fold increase from 6 per 1000 women for 5 years of use to 19 per 1000 women for 10 years in the Million Women study.3 Breast cancers diagnosed in HRT users were more advanced at diagnosis and had a 22% higher risk of mortality.2,3 Recent and past study confirm that progestogen/oestrogen combinations increase risks of venous thromboses, strokes and heart attacks and the WHI study investigators concluded that combined HRT did not have a clinically meaningful effect on health-related quality of life.4 Following a Solvay sponsored national HRT debate for specialists in 1997, I received a letter from David Purdie telling me that, “Some day, you will realise that the normal plasma estrogen of an adult woman is necessary for the optimal functioning of her bones, arteries and brain”. If I had taken such advice personally, I would have had to take a combination progestogen/oestrogen as, like most women, I have not had a hysterectomy. I would have increased my risk of headache, migraine, weight gain, hypertension, venous thrombosis, heart attack, breast, endometrial and ovarian cancer, skin melanoma, liver and lung cancer. I would have doubled my risk of dementia and increased my risk of committing suicide or dying from accidents or violence. True, women with troublesome symptoms women need individual advice but it usually needs to be based on the results of relevant biochemical and microbiological investigations. Hidden infections, positive gut fermentation results and exocrine pancreatic and nutritional deficiencies are often the legacy of past oral contraceptive or HRT use. I have been carrying out such investigations on my patients for 30 years and find many abnormalities needing specific treatments.5 Low postmenopausal oestrogen levels after the menopause are natural but adequate brain and cell function needs adequate levels of essential nutrients, especially zinc, magnesium and essential fatty acids, at all ages. Whatever happened to basic medicine? 1.www.rcpe.ac.uk/esd/consebsus/statements.html. 2. Chlebowski RT, Hendrix SL, Langer RD et al, for the WHI Investigators. Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: The Women’s Health Initiative randomised trial. JAMA 2003;289:3243-53. 3 Million Women Study Collaborators. Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet 2003;419-27. 4 Hays J, Ockene JK, Brunner RL, et al, for the Women’s Health Investigators. Effects of estrogen plus progestin on Health-related quality of life. NEJM 2003; 348: 4 Grant ECG. The Pill, hormone replacement therapy, vascular and mood over -reactivity, and mineral imbalance. J Nutr Environ Med1998;8:105-16. Competing interests: None declared |
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Elizabeth H Price, Consultant Microbiologist Royal London Hospital, Whitechapel, London E1 1BB
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The consensus statement on hormone replacement therapy (HRT) referred to in the BMJ news round-up, claims that it alleviates hormone-related mood change.(1) This was not my experience. I found that taking HRT was associated with mood swings that disappeared within a week of stopping this drug. Similar effects have been noted in the published literature.(2) Large studies of progestogen and oestrogen combinations, taken either as oral contraceptives or HRT, have found an increase in mental illness, violence and injury and included suicide and suspected suicide. A more recent study, the Women's Health Initiative (WHI), concluded that combination HRT did not have a clinically meaningful effect on health-related quality of life(3) and increases the risk of developing dementia.(4) Some of the basic mechanisms for these adverse effects on emotions and behaviour in women have been described since the early 1960s.(5) Sex steroid hormones can also cause chemical imbalance, including alteration in vitamin and mineral status which may have further a effect on mood.(5) Rather than looking for psychological explanations, it is important to recognise the powerful effect that prescribed sex steroid hormones may have on mood and behaviour. References 1. Specialists clarify when the benefits of HRT outweigh the risks. BMJ.com news roundup. BMJ 2003;327:888 2. Price E. Increased risk of mental illness and suicide in oral contraceptive and hormone replacement therapy studies. J Nutr Environ Med 1998;8:121-127 3. Hays J, Ockene JK, Brunner RL et al. Effects of estrogen plus progestin on health-related quality of life. N Eng J Med 2003;348:1839- 1854. 4. Schumaker SA, Legault C, Rapp SR et al. Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the Women's Health Initiative Memory Study: a randomized controlled trial. JAMA 2003;289(20):2651-2662. 5. Grant ECG. The pill, hormone replacement therapy, vascular and mood over-reactivity, and mineral imbalance. J Nutr Environ Med 1998;8:105-116. Competing interests: None declared |
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Elizabeth J Hallworth, Engineer Intersil, CM19 5QA
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I notice Ellen CG Grant that you reply to a lot of articles on HRT and seem very against it as a treatment? I have a question, before 1995 there seemed to be a lot of support for, and scientific studies supporting HRT use. Then suddenly after the WHI study opinion seems to have swung the opposite way. But I've read comments saying the WHI study was flawed for a number of reasons, the most notable in my eyes being the women in the study didn't need the treatment? My main concern is I take HRT for PMDD and no doctor has ever offered me a hormone test, apart from after starting HRT (despite me requesting one). And no doctor has ever mentioned that HRT can cause mineral deficiencies (something I have also asked for tests for). HRT has been the only treatment which has offered me quality of life. If there was an alternative I would use it but doctor's don't offer any explanations for PMDD or safe alternative treatments. Personally I don't think it's 'natural' to suffer from depression 3 weeks out of 5 EVERY month. Also is transdermal bioidentical oestrogen patches and bioidentical progesterone as unsafe as the synthetic analogues used in the WHI study? I feel this is something that should be investigated as synthetic contraceptives caused some of my PMS symptoms and it wouldn't suprise me if they were the cause of my hormone problems as I didn't get migraines before i took the pill but have ever since despite not taking it for years now. I've also had significant depression after taking synthetic progesterone, something i don't get from natural progesterone. Doctor's don't seem to distinguishe between bioidentical hormones (except in the one article I found on website below) which I feel is wrong because I get far more side-effects from synthetics.. http://www.zrtlab.com/Page.aspx?hid=383 Competing interests: None declared |
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