Hormone havoc

From cow ovaries to horse piss, hormone replacement therapy has run the gamut from primitive to crude

Photo By David Robert

One hundred years ago, one medicinal option to help women get through the hot flashes, night sweats, headaches, and emotional fluctuations of menopause was an enticing creation appropriately named “Ovariin.” Offered in powdered or pill form, Ovariin was made from dried and crushed cow ovaries. Yet Ovariin wasn’t the only option for menopausal women. Merck, the company that developed Ovariin, also suggested that menopausal women use cannabis and opium to help them get through “the change.”

Perhaps the medicine of 100 years ago can be dismissed as primitive. Surely we have come a long way from feeding women the hormones of farm animals to treat a natural stage of biological progression. Surely women have far better options today.

But do they?

In July 2002, as the results of the Women’s Health Initiative started to hit newscasts, menopausal women began to see just how confusing their options in the modern age are. The study, which used 16,608 women to examine the most common type of hormone replacement therapy (HRT), a combination of estrogen and progestin (realized in the prescription drug Prempro), demonstrated that HRT could increase risk for breast cancer, heart attack and stroke.

Suddenly HRT—an option hailed by doctors and the media for years as an effective, healthful treatment of menopause that promised protection against heart disease, osteoporosis and strokes—sounded as crazy as ingesting pulverized cow ovaries.

Just this year, numerous additional studies have come out confirming that the risks of HRT outweigh the benefits. In May, the Journal of the American Medical Association reported that combination HRT increases risk of dementia. In August, a British study verified that the death rate from breast cancer is higher in women on combination HRT. In September, the Journal also reported that the risks involved with HRT outweigh the osteoporosis-related benefits. In October, another sector of the WHI study concluded that HRT may increase the risk of ovarian cancer, while a European study linked HRT with asthma. The results of these studies leave the more than 10 million women who use menopausal hormone therapies frustrated, confused and asking, “How could this have happened?”

In her new book, The Greatest Experiment Ever Performed on Women, Barbara Seaman argues that the practice of prescribing hormones got ahead of science mostly due to the power and pressure of money-hungry drug companies. Seaman claims that doctors and drug companies recklessly provided poorly researched hormones to women, hoping for positive results.

“Over the years, hundreds of millions, possibly billions of women, have been lab animals in this unofficial trial,” she writes. “They were not volunteers. They were given no consent forms. And they were put at serious, often devastating risk.”

The risk that Seaman writes of comes as no shock considering that the real lab animals used to test estrogens in the 1930s and 1940s had higher rates of miscarriage, breast cancer and blood clots.

British scientist Charles Dodds, the man who first published a formula for estrogen in 1938, was quick to qualify his discovery by warning that hormones could cause breast cancer and endometrial cancer. In 1941, Edgar Allen, the scientist who, 20 years prior, had discovered how female hormones work, published an article stating that that estrogen was proven to cause cervical cancer. Yet, in 1942, ignoring the advice of leading experts in the field, the FDA approved Premarin (a hormone derived from the urine of pregnant horses) to treat menopausal symptoms.

By 2000, Premarin would reach $1 billion in sales and become the biggest-selling brand name drug of the 20th century.

The wave of outrage that hit in the summer of 2002 and continues with every alarming new report on HRT is not unprecedented. A year before the FDA approved Premarin, it approved the estrogen diethystilbestrol. As a means to prevent miscarriages, a function that DES was never proven to have, more than 4 million women between 1941 and 1971 were prescribed the drug with horrific results to women’s (and their children’s) reproductive organs.

Hormone use was also questioned in 1975, when studies linked estrogen and endometrial cancer. As a result, Premarin prescriptions plummeted by 50 percent. Sales for Wyeth-Ayerst, the drug’s manufacturer, were in trouble. The solution: market Premarin as a treatment for osteoporosis. In 1986, the FDA approved HRT for this purpose, and by 2000 there were over 46 million prescriptions for the drug.

With the fallout from the WHI study, women have learned the hard way that the problem with handing our bodies, health, and faith over to medicine is that medicine sometimes gets it wrong. The dangers of pathologizing women’s bodies has been realized in the HRT chaos. Medicalization of normal biological functions makes women medicine-dependent and unfamiliar with their own bodies. When menopause is perceived as a disease, women perceive themselves as diseased. They become helpless.

A system that pathologizes women’s bodies does not benefit women because women’s experiences become streamlined and regulated. For years, HRT was prescribed in the same doses to massive amounts of women with varying ailments. As one practicing OB-GYN revealed about the effects of the WHI study, “It forced us to individualize HRT for each patient, instead of prescribing it en masse without any counseling.”

In the wake of women’s confusion and frustration over HRT, the FDA debuted a section of its Web site (www.fda.gov) last month, aiming to clarify facts about menopause and HRT. The site offers a “purse guide,” a list of questions women should ask their doctors about HRT, but again the maxim is instilled that a woman needs a doctor to treat menopause.

In terms of more options, the FDA has approved a lower-dose formulation of Prempro and a new estrogen-based skin cream called “Estrasorb.” Both new products, however, get the same warnings as older forms of HRT.

Women deserve better options for managing menopause 100 years after crushed ovaries and narcotics were their best bet. While the results of the WHI study were enlightening, knowledge about HRT is still very limited. Because Wyeth-Ayerst agreed to provide Premarin free to the researchers of the WHI, we only know for sure that Premarin’s specific formulation is linked to the documented results.

While many women advocate natural remedies for symptoms of menopause, including soy, ginseng and flax seed, the safety of these remedies is still being tested. It’s clear that women want other options beyond HRT. A recent New Zealand study of HRT patients found that 58 percent of its participants ceased hormone use in reaction to the WHI study. In October, Wyeth-Ayerst announced a 50 percent reduction of Premarin production (which, by the way, will save 20,000 mares from standing in tiny stalls as their urine is collected for all 150 days of their gestation periods).

Last month, scientists reported the first successful ovary transplant in rhesus monkeys. It was hailed as a breakthrough, as something that gave hope that medicine might one day “cure” menopause. But menopause doesn’t need a cure. Women may want to seek help getting through it, but the suggestion that menopause should one day be cured is offensive. Diseases are cured, and menopause is not a disease. It’s an inevitable part of a woman’s life, and she shouldn’t be made to feel that it needs to be fixed or, better yet, totally eliminated from her experience.

The best option for women is to know their own bodies and to make their own informed decisions in regard to what they choose to put into their bodies. Women must demand individualized care and treatment. Better medical research is needed, but women must have the courage to trust themselves, for women are the only true experts on their own bodies.

One menopausal woman I spoke with said, "I trust me … and I love my doctor, but it’s my health, it’s my body, it’s my responsibility."