Medical treatment for menorrhagia may only delay hysterectomy
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7442.730-d (Published 25 March 2004) Cite this as: BMJ 2004;328:730
All rapid responses
Hilary Butler asks about the antipyrine clearance test. This is a
sensitive test for assessing the effects of diseases or drugs on liver
function.1 . Antipyrine is a drug like aspirin. The liver normally clear
the drug in 10 - 12 hours in healthy women. We used this test as part of a
Migraine Clinic research project in 1979.2 Women with migraine and
controls were given a single dose of antipyrine. The rate of clearance of
antipyrine from their plasma was determined. Plasma copper and zinc levels
were also measured (reported range for copper:zinc ratio being 1.0-1.4).
Both low zinc and high copper levels are associated with some forms of
liver impairment.
The results for the migraine patients fell into 3 groups. Over a
third of the patients had delayed clearance, averaging over 17 hours and
they also had an abnormally high copper;zinc ratio, which averaged 2. One
in five patients had abnormally fast clearance rates. Most women had used
oral contraceptives. Hormone use is known to delay liver clearance and
lower zinc and raise copper levels.3 Some had been smokers which can
speed up drug clearance.
As far as I know the antipyrine clearance test is not generally
available, but copper and zinc concentations can be assessed by analysing
concentrations in red and white cells respectively. Copper and zinc are
important enzyme co-factors and deficiencies of these essential nutrients
impair liver function, which results in an increased number of foods
causing adverse reactions following an exclusion diet.
1. Stevenson IH. Factors influencing antipyrine elimination. Br J
Clin Pharmac 1977;4:261-265.
2.Capel ID, Grant ECG, Dorrell HM, et al. Disturbed liver function in
migraine patients. Headache 1979;19:270-272.
3. Homeida M, Halliwell M, Branch RA. Effects of oral contraceptives
on hepatic size and antipyrine metabolism in premenopausal women. Clin
Pharmac Therap 1978; 24:228-232.
4. Vestal RE, Norris AH, Tobin JD, etal. Antipyrine metabolism in
man: influence of age, alcohol, caffeine, and smoking. Clin Pharmac Therap
1975;18:425-440.
Competing interests:
None declared
Competing interests: No competing interests
Dear Sir
Ellen Grant says:
***As most women have used hormones, smoke and drink alcohol, many
will have impaired liver function. Even if the usual liver tests are
normal, an antipyrene clearance can show that hormone users and smokers
are more likely to have impaired liver function and increased reactions to
foods and chemicals because of an abnormal copper /zinc ratio.5 Impaired
superoxide dismutase activity can be corrected with zinc 30 mgs each night
and copper 1 mg each morning for two weeks, plus manganese 5 mgs.
Apart from undiagnosed cervical or endometrial infections, such as
mycoplasmal, women with unexplained bleeding may also be deficient in
magnesium and essential fatty acids. Avoiding hormone use, smoking and
alcohol and an individualised high protein, low allergy diet can prevent
headaches and migraine and endometrial vascular over-reactivity and,
therefore, in theory, also idiopathic menorrhagia.***
What I would like to know, is: "Why have I **NEVER** been told any
of this before?".
Or any of my friends.
May the medical world somehow clone the "Ellen Grants" of this world,
and for goodness sake, give us women some gynecologists who will give us
information, and options.
Just think how much misery could be prevented if we women were
**INFORMED ** as in the above manner, and successfully implemented that
advice, instead of just put on the factory line for drugs, and operations?
Think of the money saved on unnecessary drugs, unnecessary
operations, and better still, better health, and resolution of other
problems, for which women are also "prescribed" expensive tests, drugs and
other unnecessary treatment.
I have never used hormones, or smoked, or drunk alcohol **BUT** did
have two episodes of Hepatitis B, 30 years ago. No-one has ever given me
any advice, of any nature other than to use what surgery or drug/IUD
manufacturers have to offer.
Everything I have done for myself, I have done "blind".
Until today, I had no idea of such a thing as an "antipyrene
clearance".
How is it that we women continue to flounder around in an
informational vacuum, just because only Ellen Grant sees the value of, and
need to offer information on non-hormonal, non-surgical solutions?
Question: What is "antipyrene clearance" and how is it tested?
Sincerely,
Hilary Butler
Competing interests:
50, and don't want a hysterectomy
Competing interests: No competing interests
Scott Gottlieb summarises two studies in JAMA finding that 42% and
53% of women had hysterectomies following aggressive medication for
menorrhagia with oestrogen, progesterone or a prostaglandin synthetase
inhibitor.1
Exogenous hormones have always been the wrong treatment for bleeding
in my opinion. Large doses of progesterone, or small doses of progestogen,
may shrivel the endometrium but can cause a disproportionate development
of endometrial blood vessels.2,3 This means that oral contraceptives
usually induce less withdrawal bleeding than a normal menstrual period but
some hormone takers have particularly well developed arterioles and they
can have heavy, irregular bleeding. In the Walnut Creek contraceptive drug
study women over age 40, who had ever used contraceptive pills, were 3
times more likely to have fibroids. Significant increases in heavy
bleeding causing acute iron deficiency anaemia, fibroids, adenomyosis,
pelvic inflammatory disease and hysterectomies were recorded in oral
contraceptive users.4
My extensive research into the hormone balance of oral contraceptives
and the endometrial vascular changes in untreated and treated cycles,
showed that irregular bleeding related to lack of oestrogen or
progesterone dominance.2 Because oestrogen given alone causes
endometrial hyperplasia and endometrial cancer, combined contraceptive or
menopausal preparations all act predominantly like progesterone to prevent
breakthrough bleeding.
Alternative practitioners have been deluded into believing that
“natural” progesterone is safe while it is only synthetic progesterones
which cause breast and cervical cancer, vascular and mental diseases and
immunosuppression in general. This mistaken belief has developed a cult
status. There is internet selling and promotion from some nutritional
supplement companies. Women, who have had severe side effects from oral
contraceptives or HRT, are lulled into a false sense of security the
relative ineffectiveness of progesterone cream which may produce only
small elevations in progesterone concentrations. However, enough may be
absorbed locally to be carcinogenic. A possible risk for a breast cancer
patient, who has already had a mastectomy, is of contralateral breast
cancer if she rubs progesterone on her remaining breast. Further hormone
exposures are known to increase the likelihood of a second cancer
developing. Localised distended veins on the rubbed skin can also happen.
Using herbs can cause irregular bleeding. In one case, a mixture of
different was found to contain nine herbs with oestrogenic actions. Herbs
may contain also oestrogenic mycotoxins and such “remedies” are
potentially teratogenic if taken in early pregnancy.
As most women have used hormones, smoke and drink alcohol, many will
have impaired liver function. Even if the usual liver tests are normal, an
antipyrene clearance can show that hormone users and smokers are more
likely to have impaired liver function and increased reactions to foods
and chemicals because of an abnormal copper /zinc ratio.5 Impaired
superoxide dismutase activity can be corrected with zinc 30 mgs each night
and copper 1 mg each morning for two weeks, plus manganese 5 mgs.
Apart from undiagnosed cervical or endometrial infections, such as
mycoplasmal, women with unexplained bleeding may also be deficient in
magnesium and essential fatty acids. Avoiding hormone use, smoking and
alcohol and an individualised high protein, low allergy diet can prevent
headaches and migraine and endometrial vascular over-reactivity and,
therefore, in theory, also idiopathic menorrhagia.
1 Gottleib S. Medical treatment for menorrhagia may only delay
hysterectomy. BMJ 2004;328:730 (27 March), doi:10.1136/bmj.328.7442.730.
2.Grant ECG. Hormone balance of oral contraceptives. J Obst Gynae Br
Com 1967; 74 :908-18 .
3 Grant ECG. Relation between headaches from oral contraceptives and
development of endometrial arterioles. BMJ 1968; 3 :402-5.
4 Ramcharan S, Pellegrin FA, Ray R, Hsu J-P. The Walnut Creek
Contraceptive Drug Study. A prospective study of the side effects of oral
contraceptives. Vol 111 CPR; NIH Publication No 81-564 ,1981.
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
Competing interests: No competing interests
Dear Sir,
I developed borderline menorrhagia with blood loss of about 70mls
(and many other symptoms) following sterilisation at age 38. I was not
happy with conventional treatment options and consulted a medical
herbalist. Within 1 cycle my blood loss was returned to pre-sterilisation
levels of about 30mls. In case anyone should label this coincidence, on 2
separate occasions I have stopped taking the herbs for 5 days during the
luteal phase (after 5 days symptoms become intolerable) and on each
occasion blood loss has increased within that cycle to about 45-50mls.
About 2 months after starting the herbs I started using transdermal
natural progesterone, which resulted in further improvements (and is side-
effect free). This combination is infinitely more effective than the
patented progestins/progestagens, which are designed solely to increase
pharmaceutical profits and have so many adverse effects. While a
hysterectomy is a simple solution for health professionals, the resulting
problems are not acceptable to me.
Don't you think it is more logical to stop using such invasive and
toxic methods when there are so many more effective, gentle and cheaper
alternatives available?
Competing interests:
None declared
Competing interests: No competing interests
Dear Sir,
The problem for many women, including myself, is that many doctors
don't look outside the square. It seems the only "options" are either
hysterectomy, hormones, of an IUD that secretes small quantities of
hormones into the uterine wall.
Seven years ago, I was faced with menorrhagia, and the first advice
was that my mother had had a hysterectomy, so had my grandmother, so had
my sister, so it was obvious that I would need one too.
I was not satisfied, as I "felt" there was something else wrong.
After all, it started quite suddenly.
For a start, I felt tired. I felt "full". I felt terrible in the
morning. My bones felt "heavy".
The doctor on a whim, did another blood test and found that I had
iron anaemia, with a ferritin level of 7, and other "abnormalities".
Getting on top of that slightly reduce the intensity of the bleeding,
but not much else.
Some symptoms of fullness and blah continued, so he did liver enzymes
and found that my Alk Phos and GGT were both raised and AST and ALT on the
top end of normal.
I went on a version of the Cabot diet, and within three months my
periods and the liver tests returned to normal.
But I got slack about what I ate, and two years ago, the menorrhagia
returned. Not only that, it appeared that I was becoming pre-menopausal.
Hot flushes, missed periods, and other symptoms became my "companions" for
nearly a year.
On a whim, the doc decided to repeat the liver tests and found that
they were higher still than previously.
So this time, I got stuck in using chinese herbs, diet, and other
quackery to clean out the liver, and not only did I reduce the liver
enzymes, ~~~ they have come WAY down, almost to the level that they were
20 years ago. Not only has the menorrhagia gone, so has the extensive
clotting that had become a monthly feature in the last ten years.
My periods are much more regular, and I haven't had one "power surge"
(hot flush) for seven months. In my case, there is nothing else that I
have done, other than drastically reduce my liver enzymes. Even more
interesting, the rosacea that had plagued me for years now, has markedly
reduced, and my face redness has substantially reduced.
Interestingly, a few of my friends who are having menorrhagia, have
gone and had liver function tests too. They too had elevated tests. They
too have returned their enzymes and their periods to "normal".
They too wonder why medical people aren't making this connection.
Perhaps its because none of this fits within the cover of the
standard text-book, or pharmaceutical recommendations.
It's all "anecdotal". And it requires commitment. Effort. Changing
your diet, and long term self care. Perhaps its perceived as "too hard".
Perhaps most people prefer the knife and a quick fix.
For me, I hope to continue this way, and not have a hysterectomy.
I feel in control of my own physiology at the moment, and hopefully,
will never have to run any of the risks attendant with the surgery
required to have part of me removed.
Hilary Butler.
Competing interests:
I'm 50, and don't want a hysterectomy.
Competing interests: No competing interests
A Warning About Natural Progesterone
Dear Editor:
In response to Dr. Ellen Grant's excellent comments about natural
progesterone cream, I want to warn others about this popular, so-called
"safe" product.
My initial suffering from fatigue, weight gain, and depression were
brought on by the Pill, which I took during the first year I was married.
Oral contraceptives also caused my thyroid to malfunction, and I
developed hypothyroidism.
What I didn't know until much later was that often the ill-effects of
the
Pill on brain chemistry and metabolism ~ not to mention a myriad of
other bodily systems ~ can be chronic even after ceasing usage. I knew
something dramatic had changed, because I had not had health
problems earlier in life.
I had been constantly researching, trying to find ways of returning
to
real wellness. Unfortunately, I ran across the wrong book...Dr. John
Lee’s 'What Your Doctor May Not Tell You About Pre-Menopause.' The
consequences of his advice were devastating.
On his recommendations, I used natural progesterone cream. Dr. Lee
claimed that it is impossible to overdose on the transdermal cream, and
that there are no significant side effects. At first, I believed him.
Following the manufacturer's information and instructions, the amount
of progesterone I used per day was between 20-30mg, split between
morning and evening doses. When I first took the cream, beginning in
May 2003, I felt great. In fact, I had more energy and ability to lose
weight than I had in about five years. I didn't need near as much sleep,
and found that I no longer struggled with depression.
However...
Within about two months of starting the cream, I developed sharp pain
in my legs, and then a lump of swelling, bruising, and localized soreness
in my calf which just got worse. That ended up being the first of two
episodes with venous blood clots in the six months I was on the cream.
Little did I know that progesterone is heavily implicated in clotting
disorders, much as the Pill is. Not one of my doctors ever made the
connection between my blood clots and the progesterone.
We also noticed that my "resting" heart rate was going through the
roof.
One day when I had been on the cream about two months, we stopped
at a blood pressure machine, and my heart rate (while wandering
aimlessly around a store) was over 120! There were several times when
my heart felt like it was pounding out of my chest. I kept putting this
down to thyroid trouble. As a doctor in LA told me later, "Yes, no
wonder you were losing weight...at the expense of your heart!"
Something else that got my attention was that I started to become
emotional in a way that I had never been in my life. Even though I wasn't
feeling overtly depressed (that I was aware of), I would burst out crying
at the strangest times, and a lot more frequently than ever before. I
started feeling overwhelmed and annoyed by things that used to be no
big deal. My temper got shorter with the kids and with my husband.
This feeling crept up on me a little at a time, but it began to get worse
and worse. I now realize, from extensive reading about the actions of
progesterone, that this is typical for a large segment of those using
hormones.
By August 2003, I knew something was really "wrong," but I couldn't
put
my finger on it. I had this feeling of unease that was growing and
growing. A pattern started where, during the week before my period
and often the week of, I would become extremely nauseous. For several
months, we were sure I was pregnant. I never was.
At the beginning of October 2003, something in my body "snapped" and
the nausea took hold in a frightening way. If I had known then that it
would last ~ without relief, for months straight ~ I don't know if I could
have borne it.
When I couldn't stop throwing up and couldn't eat and it had been
three
weeks - that was when I ran across the first doctor who said, "Well, if
there's one thing I know that makes pregnant women sick as dogs, it's
progesterone. I'd look there first, if you want to know why you can't
stop vomiting." I quit the cream on October 26, 2003.
The bad news, which I got soon after, was that progesterone cream
builds up in the tissues and takes anywhere from three to six months to
be cleared by the body. This timeline ended up being almost exactly
true for me. I was sick, sick, sick until about two weeks ago.
The symptoms during those six months of illness as I rebounded from
the cream are almost too many to list, but they include: severe nausea
and vomiting, gastro-intestinal problems (marked heartburn, bouts of
diarrhea, and bouts of constipation), uncontrollable shaking, acne and
extremely oily skin, hirtuism, depression, anxiety, tingling/burning
sensations on the back of my arms, neck, and head, insomnia, hyper-
sensitivity to medications and foods, hot flashes, and serious withdrawal
symptoms. To my great relief, most all of these issues have finally,
completely resolved. Today, only the insomnia remains.
It turns out that *lots* of people are having trouble with natural
progesterone cream. A hormone researcher confirmed that my
symptoms were quite consistent with excess progesterone.
On his web site, Dr. Mark Rhodes writes:
"Many people overdose from prolonged use of progesterone cream. It is
promoted so heavily, so easily available, so inexpensive, and so readily
absorbed. The real problem is several-fold in my opinion. It is difficult
to
get an exact individual dose. Because it does relieve a number of
symptoms of estrogen dominance, I am sure that some use more than
they should. But the most insidious problem comes from long-term use.
Many women who use a topical progesterone product end up having it
accumulate in their tissues. It then can release into the blood stream at
very high levels . And we see this high-level release occur for months
after the patient quits application..."
Information about other doctors experiencing problems in
patients taking progesterone cream available at:
http://www.mercola.com/article/progesterone/cream.htm
Neither blood serum nor saliva tests are accurately revealing the
high
levels of progesterone that the creams can cause. Many women - and
I'm one of them - show up in these tests as having LOW progesterone
levels even when their bodies have become toxic due to overdose! This
really threw my doctors off the trail. They wanted to put me back
ON progesterone, but thankfully I was never willing.
Lots of researchers seem to be catching on to the fact that natural
progesterone can be anything but harmless. The following information
was released last week by the American Society of Clinical
Pharmacologists:
http://ascpt.org/press/2004/2004NewResearch.htm
I realize this letter is long, but if one woman is spared the misery
I
endured, it will be worth sharing what happened. I hope that more and
more people will seriously reconsider their advocacy and use of
hormones, whether "natural" or not.
Cathy Groves
Competing interests:
"Natural" Progesterone
Cream nearly killed
me!
Competing interests: No competing interests