Kicking the hormone habit - Canadian Writers Group

B o d y
mind
by rona maynard
Kicking the
hormone habit
michael crichton
my name is rona
and i am an
estrogen addict
I had just unpacked my bag in a London hotel room when I felt a shiver of
alarm. Where was the vial of little blue pills that allow me to sleep, think, avoid emotional
meltdowns and generally feel like myself? I ransacked every corner of the bag
— once, twice, 147 times. I emptied my purse and poked inside the toes of shoes until
there was nowhere left to look. If I had to leave something behind in Toronto, why
couldn’t it have been my toothbrush? Without my estrogen fix, our 10-day vacation
would plunge me into hormone hell. I threw myself on the mercy of the closest
chemist (as British pharmacists are called). But by law he could not fill a prescription
from my doctor back home. The result: a whole day spent tracking down the clinic
where, for a substantial fee that in my desperate state seemed like a bargain, a boredlooking
doctor scribbled on her pad, saving me from night sweats and brain fog.
December / January 2011 / More / xx

Along with the little blue estrogen pill, I take a big white
one, progesterone. Both hormones work together to regulate
the menstrual cycle, and they’re prescribed together
for hot-flashing midlifers like me who still have a uterus
(estrogen on its own can cause endometrial cancer). But
I’ve always viewed progesterone as estrogen’s humble sidekick,
and no wonder. It’s estrogen that repeatedly dominates
discussions of so-called combined hormone therapy
— confoundingly cast as both the key to women’s vitality
and a serious threat to our health.
My heart sinks whenever I read that yet another study
has raised a warning flag about estrogen. I keep promising
myself that one day soon I’m going to kick my estrogen
habit. I don’t like feeling so dependent
on the stuff that I’d pay any price to
replace it. But I want to be me, not a
sleep-deprived wraith. I’ve made two
attempts to quit the pills by gradually
tapering the dose; both times I gave
up within weeks. I never planned on
becoming an estrogen lifer, but I seem
headed that way. What am I doing to
myself? In an effort to reassure hormone-phobic
women, the Society of
Obstetricians and Gynaecologists of
Canada has declared combined therapy
“safe and effective” for relieving
symptoms like mine — but only for
short-term use, five years at most.
It’s been 15 for me.
At 45, I was the first in my circle to
jump on the hormone bandwagon.
The results seemed nothing short of
miraculous. A few months into the
job of a lifetime, editor-in-chief of Chatelaine, I’d been arriving
bleary-eyed at the office and barking at my staff.
How could I keep this up? My doctor told me I had the
most treatable of problems: estrogen deficiency. Just to be
sure, he gave me an estrogen injection that restored my
spirits overnight, proving to his satisfaction and mine that
the time had come for the little blue pill, synthetic estrogen
— supposedly a veritable wonder drug. It would protect my
heart, strengthen my bones and ward off dementia while
keeping my skin and vagina youthful. I started singing its
praises to strung-out, middle-aged friends.
Then one fateful summer morning in 2002, news broke
that a major hormone trial, part of the 15-year Women’s
Health Initiative (WHI) study, had been abruptly terminated
for ethical reasons. Researchers had detected an increased
risk of breast cancer, heart disease and stroke
among women on combined hormones. Dismayingly, women
and their doctors had been counting on this trial for
I never planned on becoming an
estrogen lifer. I’ve made two
attempts to quit the pills; both
times I gave up within weeks.
proof that estrogen lived up to its billing. Now it seemed to
have proven just the opposite. I’d no sooner sat down at my
desk than a friend called in a panic. No more hormones for
her! And just when did I plan to pitch my “cancer pills”?
She didn’t think much of my answer: Risk is part of life and
I intend to enjoy mine while I can. That’s basically been my
position ever since. But I’d like to know for sure that I’m
not kidding myself.
You don’t hear much about long-time users like me. It’s
hormone refuseniks who get the attention. They’re the
reason why breast cancer rates have been dropping since
the WHI bombshell, according to a Harvard study that
made headlines last winter. Predictably, the study has critics
who cite other possible reasons
why breast cancer rates have plummeted,
but there’s just no denying
one troublesome fact: The drop occurred
only in white, non-Hispanic
women over 50. These were the very
women most likely taking combined
hormone therapy — until they began
to reject it. In September, a Canadian
study made the same connection
between the flight from hormones
and a marked drop in breast cancer
incidence (almost 10 per cent). Good
luck waiting for future research to reach a more comforting
conclusion. As Nancy Krieger, an epidemiologist
and lead author of the Harvard study, told Newsweek,
“How can you ask women to take a drug that you know
causes them harm?”
I like to think the benefits of feeling like myself more than
justify whatever risks I’m taking. After all, I lead a healthy
life. I’ve never smoked, I work out faithfully, I eat my quinoa
and leafy greens. I’ve been slim ever since I lost my
pregnancy weight at 22. All of these things help prevent any
number of diseases, including the one that women fear
most — breast cancer. And when it comes to that particular
scourge, an early pregnancy like mine is known to have protective
effects. I’ve just about convinced myself that if medical
science could put my entire health history in a test tube,
shake it up and give me a score, I’d get at least an A minus
for cancer prevention, never mind the hormone pills. Even
so, I can’t suppress occasional flickers of unease.
xx / More / December / January 2011

B o d y
mind
No surprise to Jennifer Blake, chief of obstetrics and gynecology
at Sunnybrook Health Sciences Centre in Toronto.
“Women are made to feel they’re doing themselves a
disservice by taking hormones,” she says. As Blake explains,
the dangers of hormone therapy have been vastly overhyped
and the nuances lost in the furor. Take the WHI findings:
Still the biggest pool of data we have on hormone
therapy, they’re the source of that five-year safety window,
which I’ve already exceeded by a decade. The participants
weren’t typical hormone users. They were older, 63 on average.
Many were overweight or had high blood pressure.
This might seem a peculiar way to study drugs prescribed
mainly for healthy women in their fifties, but WHI’s vast
scope went beyond hormones. The researchers were also
looking at the role of diet and dietary supplements in keeping
women well. They needed statistically significant data
on heart attacks, which are more common in older women,
and this fact skewed their results.
As for breast cancer, Blake wishes women would look at
the big picture. Obesity and poor diet pose the same risks
as hormone therapy; so do delaying or foregoing pregnancy,
early menstruation and late menopause. What’s more,
women now have alternatives to the combination of hormones
— estrogen and synthetic progesterone, or progestin
— that caused the elevated cancer risk. I take a plantderived
progesterone called Prometrium that precisely
mirrors the chemical structure of what the female body
produces. Two years ago, a French study found that estrogen
plus bio-identical progesterone did not cause breast
cancer. Why didn’t I hear about this sooner?
The hormone therapy decision has been widely reduced
to a simple question: yes or no? Yet researchers have been
shifting their sights to a more meaningful question: when?
Earlier seems to be better. Remember those alarming reports
about hormones as a risk factor for dementia? They
were based on WHI subjects in their sixties. Newer studies
suggest that women who start estrogen in their fifties, before
age has begun to compromise their brains, will gain
protection from dementia. Roberta Brinton, a professor of
pharmacology at the University of Southern California in
Los Angeles, has shown that estrogen helps the female brain
to fuel itself efficiently and respond to stimuli. Since Alzheimer’s
has ravaged my family tree, I’d like to think the
little blue pills have bought me a few productive years. But
the only thing I know for sure is I feel better on hormones.
According to Blake, that’s reason enough to stay the course.
I hear a radically different story from Jerilynn Prior, an
endocrinologist at the University of British Columbia in
Vancouver, the driving force behind the Centre for Menstrual
Cycle and Ovulation Research (CeMCOR) and coauthor
of The Estrogen Errors. Prior denies there’s any such
thing as estrogen deficiency — or that estrogen levels wane
in the run-up to menopause, known as perimenopause,
when up to 20 per cent of us feel nothing like ourselves.
What really cause our symptoms are sudden estrogen spikes.
And the safest treatment is not more estrogen but bio-identical
progesterone — that big white Prometrium pill on its
own and in a larger dose than I’m currently taking.
In a menstruating woman, monthly progesterone levels
peak at more than a thousand times the peak estrogen level.
Yet a woman on hormone therapy takes roughly the same
estrogen dose her body once produced naturally and only
one-quarter the progesterone. Prior is asking what’s wrong
with this picture.
Her stand hasn’t won her any friends in the medical establishment.
She’s often had to fund her own research with
private donations. In a new study of 114 women, Prior found
that Prometrium can relieve hot flashes within four weeks.
In addition, it promotes sleep and strengthens bones. Not
bad for a hormone that has no rap sheet. As for estrogen,
Prior dismisses the hope that research now underway will
uncover good reasons to take it at the right time. She accuses
mainstream medicine of rigid loyalty to a groundless
faith in estrogen’s importance. She writes in The Estrogen
Errors: “Estrogen was not and is not useful in preventing
disease and has, in fact, been shown to cause harm.”
If you google “stopping estrogen therapy,” the first site is
the CeMCOR site. “Women are just desperate,” says Prior.
Herself the veteran of a tough perimenopause, she has posted
a bracing and helpful guide to kicking the estrogen habit.
Step one: Increase your progesterone to 300 milligrams
(triple the standard dose, and the amount your body naturally
produces in the last two weeks of your monthly cycle
until perimenopause hits). Step two: Switch to the estrogen
patch because you can cut it up for more gradual tapering.
Step three: Give yourself 15 weeks and be prepared to bump
up the estrogen temporarily if the going gets rough.
Don’t be surprised if it does. Says Prior: “My latest wild
idea is withdrawal from estrogen is like withdrawal from
opioids [such as heroin and morphine].” She points to studies
showing that estrogen promotes addiction in female rats,
which get hooked faster than males. Removing a rat’s ovaries
will protect it from addiction, but dependence returns if
it is then given estrogen. (With women the picture is not so
clear, but it looks as if progesterone helps female addicts
recover by easing stress and counteracting the drug high.)
Okay, I admit it. My name is Rona and I am an estrogen
addict. Now I know I have an alternative besides toughing
out withdrawal. If I were just entering the hot-flash zone,
I’d give progesterone a try. But for now, anyway, I’m sticking
with the tried and true. I’ll never know the consequences
of my choice, and I’ve decided that’s okay. Much as I hate
to admit it, I’ll eventually die of something. Why not savour
every minute of the time I’ve got? M
December / January 2011 / More / xx