Women's Bodies, Women's Wisdom (127 page)

LONG-TERM HEALTH CONCERNS

Breast Cancer

The most common concern women have about taking hormones is the fear of breast cancer, and it’s the main reason many women don’t want anything to do with hormone therapy, even when it could help them. I believe that if the estrogen and progesterone used in HT were bioidentical, as previously described, and if they were used at dosages tailored to an individual woman, we would not find an in crease in breast cancer risk.

Jerilynn Prior, M.D., founder and scientific director of the Centre for Menstrual Cycle and Ovulation Research (CeMCOR) in Vancouver, British Columbia, believes that progesterone might actually decrease the risk for invasive breast cancer because studies show it opposes the effects of estrogen.
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Her research shows that estrogen levels are significantly higher than normal during perimenopause.
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To counterbalance these high levels of estrogen, Dr. Prior, coauthor of
The Estrogen Errors
(Praeger, 2009), prescribes progesterone to successfully treat hot flashes, low bone density, and menstrual problems. I agree with her practice.

Dr. Isaac Schiff, chief of Vincent Memorial Obstetrics and Gynecology Service at Massachusetts General Hospital in Boston, keeps a breast cancer risk chart on his desk to help his patients see clearly what the estrogen–breast cancer statistics really mean for them personally. I have found this approach so helpful that I have repro duced the chart here. Risk of breast cancer must be kept in perspective.

TABLE 8

T
HE
E
FFECTS OF
H
ORMONE
T
HERAPY ON
B
REAST
C
ANCER
R
ISK

Source:
Cancer Statistics Review 1973–1989, excerpted from the August 1995 issue of the
Harvard Women’s Health Watch,
© 1995, President and Fellows of Harvard College.

As already mentioned, there is an association between excessive amounts of carbohydrates in the diet and breast cancer, so keep the amount of refined carbohydrates in your diet moderate.
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Also, in a controlled trial of alcohol intake, women receiving oral Premarin and those on estrogen had an average 300 percent increase in estradiol levels for five hours following ingestion of alcohol. Those not receiving hormone therapy showed no comparable increase. Women should consequently be counseled to limit alcohol intake when on oral hormone therapy.
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Optimal approaches for a woman with breast cancer concerns include avoiding estrogen; using estriol, small amounts of progesterone, and botanicals; or using the minimum effective dose of estradiol or estrone. (See Program to Promote Healthy Breast Tissue in chapter 10, “Breasts.”) Remember, too, that regular exercise dramatically decreases the risk of breast cancer.

Heart Disease

Heart disease is the leading killer of postmenopausal women. If you have any personal or family history of heart disease, understand that diet and lifestyle changes can reverse or greatly alleviate your risk of getting it, with or without estrogen. Chief among the risk factors for heart disease is increased insulin resistance, which is present to some degree in 50 to 75 percent of women in this country. Problems with insulin and overconsumption of refined carbohydrates result in increased body fat and aberrations in lipid profile.
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(See
chapter 17
.) An enor mous amount of data exists on the link between nutrition and heart disease, particularly with regard to the ill effects of excess insulin and the benefits of antioxidants. A 1997 study reported in the
American Journal of Clinical Nutrition
demonstrated that a diet too high in car bohydrates and low in fat increased the risk of heart disease because of its adverse effects on lipids and insulin. The authors concluded that given their results, “it seems reasonable to question the wisdom of recommending that postmenopausal women consume low-fat, high-carbohydrate diets.”
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I couldn’t agree more. It has also been demonstrated that in individuals with stable angina (chest pain), a high-carbohydrate meal will induce a reduction in blood flow to the heart during a treadmill test much more quickly than a high-fat meal.
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This is because the surge in high blood sugar following a refined carbohydrate meal creates free-radical damage in the lining of blood vessels that causes them to go into spasm. Over time, high blood sugar also hastens atherosclerosis.

A lifestyle characterized by overconsumption of trans fatty acids and refined carbohydrates, combined with inadequate amounts of protein and micronutrients and a lack of exercise, sets the stage for cellular inflammation, which in turn creates a predisposition to hypertension, diabetes, and heart disease.
¹¹¹
By contrast, a diet that contains fish oil has been found to reduce the incidence of heart disease better than statin drugs in a number of studies. As a matter of fact, the regular consumption of fish oil reduces all causes of mortality, not just heart disease.
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I’d recommend two servings per week of sardines, mackerel, salmon, or swordfish that is virtually mercury free
¹¹³
(such as products from Vital Choice Seafood; for more information, call Vital Choice at 800-608-4825 or visit
www.vitalchoice.com
). If you are a vegetarian, high-quality flaxseed oil, ground flaxseed, hemp seed oil, or macadamia nuts or oil can be beneficial. (See Resources.) Also follow the dietary guidelines in chapter 17.

Weight-bearing exercise can also be very helpful because it lowers insulin resistance dramatically. (See
chapter 18
.) It will help increase lean muscle, and because lean muscle mass has a higher metabolic rate than fat, it helps to burn excess body fat and thus lower the risk of heart disease. Women who perform such exercise live an average of six years longer than those who do not. Recent studies have shown that natural progesterone has a protective effect on coronary arteries in women. In addition, low levels of progesterone (common during perimenopause) or consumption of synthetic progestins increase the risk of coronary artery spasm and subsequent chest pain in women. Natural progesterone has been shown to be very helpful in this regard—and at very low doses (one-quarter teaspoon of 2 percent progesterone cream applied to the skin).
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For those women who are already on synthetic progestin in the form of Provera, Amen, Cycrin, or Prempro, I recommend switching to natural progesterone. A study at the Oregon Regional Primate Center induced heart attacks by injecting chemicals into several groups of monkeys whose ovaries had been removed to simulate menopause.

One group was on Provera, one was on estrogen, one was on estrogen plus natural progesterone, and one was not on any hormones. They found that the monkeys on Provera had an unrelenting constriction of their coronary arteries, cutting off blood flow. These monkeys would have died had treatment not been initiated. The chemicals produced the same effect in those monkeys not on any hormones at all. But in the monkeys on estrogen alone, and those on estrogen plus natural progesterone, blood flow was quickly restored with no treatment necessary.

Clearly, the take-home message is this: Get off Provera or Prempro if you are using it for hormone therapy and substitute bioidentical progesterone. (In all fairness, the 2006 reanalysis of the data from the Women’s Health Initiative study and Nurses’ Health Study showed a decreased risk of heart disease in women who started HT within ten years of menopause, and the risk of heart disease was decreased by 11 percent even in those using estrogen plus synthetic progesterone. But the risk reduction was even better [44 percent] in women on estrogen alone—which may point to the adverse effect of the synthetic progestin.)

Some women experience heart palpitations in menopause, often related to emotions such as panic, fear, and depression, all of which raise adrenaline levels, which causes blood pressure and heart rate to increase. Biofeedback such as the HeartMath technique described earlier (see section on adrenals in this chapter) can help dramatically with this symptom. St. John’s wort may also be helpful (see section on mood swings and depression in this chapter). Regular expressions of joy and creativity are important for a healthy and functioning cardiovascular system and, in the end, are likely to be the best prevention. These emotions reduce levels of stress hormones. Louise Hay likens blood flow to the flow of joy throughout the body. The more pleasure and joy you take in life, the more freely the blood flows!

ALZHEIMER’S DISEASE

The fuzzy thinking many women experience perimeno pausally is not a symptom of Alzheimer’s disease, but it is important to understand what factors are associated with Alzheimer’s, the most common cause of dementia— accounting for more than half of all cases. (Other forms of dementia are caused by hardening of the arteries in the brain and by the effects of chronic alcohol use and a nutrient-poor diet.) Currently, 5.3 million Americans have Alzheimer’s disease, including 5.1 million people (one in eight) age sixty-five and older. Every seventy seconds, someone in America develops this debilitating disease. Experts estimate that by the year 2050, there will be nearly a million new cases of Alzheimer’s every year, with the total number of patients between 11 and 16 million.
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While Alzheimer’s is frequently portrayed as a disease targeting women more often than men, that’s true only in data from Europe and Asia. U.S. data show the incidence is split fairly equally among women and men.
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Though it’s hard to predict exactly who will eventually be diagnosed with dementia, a long-term study of nuns showed that those with the highest cognitive function in early life were the least likely to develop Alzheimer’s disease decades later.
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Women who maintain normal memory and brain function throughout life tend to share a set of characteristics, which include:

Good health

Financial security

Above-average intelligence and education