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The Truth about Osteoporosis

A crippling disease that is preventable and reversible

By John R. Lee, M.D. and Virginia Hopkins

Although cardiovascular disease is the leading cause of death among American women, osteoporosis is the disease they are most likely to develop as they age. Four out of ten white women in the U.S. will fracture a hip, spine, or forearm due to osteoporosis. As many as five out of ten will develop small fractures in their spine, causing great pain and a shrinking in height. This amounts to 15 to 20 million people affected by a crippling and painful disease that is almost entirely preventable and reversible.

Osteoporosis is a gradual decrease in bone mass and density that can begin as early as the teen years. Bone mass should be at its peak in our late 20s or early 30s, but thanks to a poor diet and lack of exercise, many women are already losing bone in their 20s. Bone loss occurs more rapidly in women than in men, especially right around the time of menopause, when an abrupt drop in estrogen and progesterone accelerates bone loss.

When you think of your bones you may imagine a dead skeleton, but your bones are living tissue, just like the rest of your body, and they need a good supply of nutrients and regular exercise. New bone is constantly being made, while old bone is being reabsorbed and excreted by the body. Our larger long bones, such as our arm bones and leg bones, are very dense, and they are completely replaced about every 10-12 years. Our less dense bones, such as our spine and the ends of our long bones, are less dense and turn over every 2-3 years. Thus, as you can see, we always have the opportunity to be creating better bone for ourselves.

We all hear about how having enough calcium in the diet and taking estrogen can help prevent osteoporosis, but there is a much bigger nutritional and lifestyle picture to look at when we are talking about preventing this bone-robbing disease. You'll be happy to know that for the vast majority of women, there is no need to take estrogen to prevent osteoporosis.

The most important element of bones is minerals. Without minerals we don't have bones. The most important bone minerals are calcium, magnesium, potassium, phosphorous and fluoride. Equally important is the balance between the minerals. Too much phosphorous or fluoride will create poor bone structure. (Nearly all of us already ingest too much fluoride.) Without enough magnesium, the calcium can't be absorbed onto the bone. Vitamins are also involved. For example, vitamin B6 works with magnesium to get calcium onto your bones.

The hormones testosterone, estrogen and progesterone are also actively involved in the making and unmaking of bone. Testosterone and progesterone build bone, while estrogen appears to indirectly slow bone loss.

In osteoporosis, the old bone is being reabsorbed faster than new bone is being made, causing the bones to lose density and become thinner and more porous. The integrity and strength of our bones is related to bone mass and density. The bones of a woman with osteoporosis gradually become thinner and more fragile. A progressive loss of bone mass may continue until the skeleton is no longer strong enough to support itself. When that happens, bones can spontaneously fracture. As bones become more fragile, falls or bumps that would not have hurt us before, can cause a fracture. Bone loss seems to be most severe in the spine, wrists and hips. Unfortunately there are usually no signs or symptoms of osteoporosis until a fracture occurs.

Early Signs of Osteoporosis

Sudden insomnia and restlessness

Nightly leg and foot cramps

Persistent low back pain

Gum disease, loose teeth

Gradual loss of height

Your Risk of having osteoporosis is higher if you:

Are a woman

Have a family history of osteoporosis

Are white

Are thin

Are short

Went into menopause early

Have a low calcium intake

Don't exercise

Smoke cigarettes

Drink more than two alcohol drinks daily

Are on chronic steroid therapy (e.g. Prednisone)

Are on chronic anticonvulsant therapy

Are taking drugs which can cause dizziness

Are hyperthyroid

Eat too much animal protein intake

Use antacids regularly

Drink more than two cups of coffee daily

How Aware of Osteoporosis Are You?

A Gallup poll sponsored by the National Osteoporosis Foundation found that:

75% of women believed they were familiar with osteoporosis, but

80% were not aware that it was responsible for disabling fractures,

90% percent were surprised to learn that osteoporosis frequently causes death, and

60% could not identify the risk factors of osteoporosis.

Should You Take Hormone Replacement Therapy to Prevent Osteoporosis?

There is a misperception that osteoporosis begins at menopause. In reality, bone mass begins declining in most women in their mid-thirties, accelerates for 3-5 years around the time of menopause, and then continues to decline at the rate of about 1-1.5% per year. Because bone loss accelerates at menopause, and because estrogen levels decline at menopause, conventional medicine has adopted the belief that osteoporosis is an estrogen deficiency disease that can be cured with estrogen replacement therapy. This is only partly true. The missing piece of this puzzle is diet and lifestyle, plus the bone-building hormone progesterone, which drops much more precipitously at menopause than estrogen does.

There is no question that estrogen can slow bone loss around the time of menopause, but the scientific evidence is very clear that after 5-6 years, bone loss continues at the same rate, with or without estrogen. A very large study published in the New England Journal of Medicine in 1995, studying risk factors for hip fractures in white women, which followed over 9500 women for eight years, found no benefit in estrogen supplementation in women over the age of 65. If estrogen was the only known treatment for osteoporosis, it might be worth taking it to get the small saving in bone density, despite all the risks and side effects. But since it's clear that progesterone, combined with proper diet and exercise, steadily increases bone density regardless of age, there are very few women who should ever need to take estrogen for osteoporosis.

Women who need estrogen tend to be those who are petite, slim and small-boned. After menopause, a woman's fat cells make estrogen, but a slim woman may not be making enough to keep up with bone loss. Those women may need a very low dose of estradiol.

There are a number of pharmaceutical drugs being used to treat osteoporosis, none of which work very well, and all of which have unpleasant side effects. One of the best known is fosamax, a biphosphonate drug that can slow bone loss. Unfortunately, the old bone which is saved by using fosamax is eventually structurally unsound, and after three or four years it has no benefit, and I suspect it tends to increase the rate of hip fracture after about five years. For awhile fluoride was being touted as an osteoporosis drug, but like fosamax, it only slows bone loss temporarily, and the long term consequence is an increased rate of hip fracture due to structurally unsound bone. Another conventional medicine osteoporosis drug is called Calcitonin-salmon (Calcimar). This is a hormone made by the thyroid gland that can temporarily slow bone loss. Again, the long term side effects are not well known, and its effectiveness diminishes rapidly after a few years.

Progesterone and Osteoporosis

One of the most important factors in osteoporosis is a lack of progesterone, which causes a decrease in new bone formation. Years of clinical experience giving women progesterone showed me that using a natural progesterone cream will actively increase bone mass and density and can reverse osteoporosis. These patients consistently show as much as a 29 percent increase in bone mineral density in three years or less of progesterone therapy. After treating hundreds of patients with osteoporosis over a period of 15 years, I found that those women with the lowest bone densities experienced the greatest relative improvement, and those who had good bone density to begin with, maintained their strong bones.

Exercise for Strong Bones: Use 'Em Or Lose 'Em

Lack of exercise is one of the primary causes of osteoporosis. Using your bones keeps them strong and healthy. Weight-bearing exercise is the only thing besides progesterone found to actually increase bone density in older women. By weight-bearing I mean exercise that uses your bones. Brisk walking counts as weight-bearing exercise, but add some hand-held weights and it's even better. Pushing a vacuum cleaner or lawn mower, gardening, dancing, and aerobic exercise also qualify.

Your exercise plan should include a minimum of 20 minutes of weight bearing exercise three to four times a week. An hour is even better. In contrast to women who exercise, those who don't continue to lose bone, regardless of what else they are doing. Studies of elderly people who fall and break a bone show that these people had poor flexibility, poor leg strength, instability when first standing, and difficulty getting up and down in a chair. Exercise can help increase flexibility, strength, and coordination. A weight lifting program of just half an hour three to four times a week can significantly improve bone density. You don't need to go to the gym to do a weight lifting program. You can lift a can of peas or a small carton of milk. Women with advanced osteoporosis should work with a physical therapist to create a safe, effective program to reduce the risk of fracture. The Asian movement exercises such as yoga, tai chi and chi kung can also be excellent for improving strength, flexibility and coordination.

Dietary Guidelines for Osteoporosis

You May Be Surprised to Learn that this is Not a Calcium Deficiency Disease

Now that scientists know the process of preventing osteoporosis begins early in life, we're hearing about sugary drinks fortified with calcium for teenagers, antacids with calcium, and calcium supplements. Osteoporosis is not a calcium deficiency disease, it is a disease of excessive calcium loss. In other words, you can take all the calcium supplements you want, but if your diet and lifestyle choices are unhealthy, or you're taking prescription drugs that cause you to lose calcium, you will still lose more calcium from your bones than you can take in through diet.

In fact, getting adequate calcium is only a small part of the prevention picture. Please pass up the sugary drinks and antacids. The damage that refined sugar will do to a growing teenage body or even an adult body far outweighs any benefit that might come from a little calcium supplementation. There is even some evidence that sugar depletes calcium, so the added calcium in these drinks may only be balancing out the damage done by the sugar. The same goes for antacids containing calcium. Since antacids tend to cause you to lose calcium, the added calcium may only offset that damage.

Having pointed out that osteoporosis is not a calcium deficiency disease, I want to assure you that getting adequate calcium is an important factor in preventing osteoporosis. Some good food sources of calcium are snow peas, broccoli, leafy green vegetables such as spinach, kale, beet and turnip greens; almonds, figs, beans, nonfat milk, yogurt and cottage cheese. I don't want you to depend on milk to get your calcium. This is because milk has a poor calcium to magnesium ratio. Your body needs a certain amount of magnesium in order to get the calcium into your bones -- without magnesium, calcium can't build strong bones.

In fact, magnesium deficiency may be more common in women with osteoporosis than calcium deficiency. Although many fruits and vegetables have some magnesium in them, especially good sources of magnesium are whole grains, wheat bran, leafy green vegetables, nuts (almonds are a very rich source of magnesium and calcium), beans, bananas and apricots.

Trace minerals are also important in helping your body absorb calcium. Eating plenty of green leafy vegetables gives you calcium along with these helpful trace minerals. Boron and manganese are especially important. Foods that contain boron include apples, legumes, almonds, pears and green, leafy vegetables. Foods that include manganese include ginger, buckwheat and oats.

The organic matter in our bones consists mainly of collagen, the "glue" that holds together skin, ligaments, tendons and bones. Zinc, copper, beta carotene and vitamin C are all important to the formation and maintenance of collagen in the body.

A Calcium/Magnesium Supplement is Good Health Insurance

Everyone should have at least 600 mg of easy-to-absorb calcium daily. Although you can easily get that much with a healthy diet, taking a calcium/magnesium supplement is an excellent form of health insurance. In fact, calcium supplements can help slow bone loss in some women. To be incorporated into bone, calcium requires the help of enzymes, which require magnesium and vitamin B6 to work properly. We tend to be more deficient in magnesium and B6 than we do in calcium.

All calcium supplements are not the same. The best absorbed form is called calcium citrate. Avoid the oyster shell calcium, as it can be contaminated with heavy metals. If you're female and over the age of 12, you should be taking 300 mg of calcium, combined with 200 mg of magnesium every day. If you can find a formula that also includes vitamin B6, so much the better. Menopausal women can take 600 mg of calcium daily with 400 mg of magnesium.

Sunshine is the Best Medicine

Vitamin D is another important ingredient in the recipe for strong bones because it stimulates the absorption of calcium. A deficiency of vitamin D can cause calcium loss. The best way to get vitamin D is from direct sunlight on the skin. Sunlight stimulates a chain of events in the skin leading to the production of vitamin D in the liver and kidneys. (This is why liver and kidney disease can produce a vitamin D deficiency.) Going outside for just a few minutes a day can give us all the vitamin D we need, and yet many people don't even do that. They go from their home, to their car, to their office, and back home, without spending more than a few seconds outdoors. Many elderly people are unable to get outside without assistance, but this should be a priority for their caretakers.

Stomach Acid

As we age, we tend to produce less stomach acid. To be absorbed, calcium, requires vitamin D and stomach acid. For this reason, it's important to avoid antacids and the H2 blockers such as Tagamet and Zantac, which block or suppress the secretion of stomach acid. Contrary to what the makers of heartburn and indigestion remedies would have you believe, the last thing in the world most people need is less stomach acid. Heartburn and indigestion are caused by poor eating habits and a lack of stomach acid. Ulcers are caused by a bacteria, not by too much stomach acid. A simple way to improve your calcium absorption may be to take a betaine hydrochloride supplement just before or with meals, to increase your stomach acid. You can find betaine hydrochloride at your health food store.

The Collagen Vitamins and Minerals

Collagen is the tissue that makes up your bone. To build collagen you need vitamin A (or beta carotene), zinc and vitamin C. Vitamin C is especially important, as it is the primary ingredient in the collagen matrix. I recommend you take 1,000 mg daily of vitamin C, in an esterfied form to prevent stomach problems.

Diet

Reduce or eliminate soda pop and other carbonated beverages.

Keep meat consumption to a reasonable level (no more than once a day).

Eat plenty of fresh, green vegetables and whole grains.

Eat foods high in flavonoids, which help stabilize collagen structures, such as blueberries, raspberries and hawthorne berries.

To Prevent Osteoporosis AVOID:

Soda Pop and a High protein Diet

I believe that one of the leading contributors to osteoporosis in the U.S. is carbonated soft drinks containing phosphorous. Research has shown a direct link between too much phosphorous and calcium loss. If you're guzzling down a couple of fizzy soft drinks a day, you're most likely creating bone loss.

Our other source of excessive phosphorous in the U.S. is eating too much meat. The average American gets more than enough protein, so for most of us it can only help to cut down on our meat consumption. A recent trend among those who love food but don't love the consequences of too much fat and protein is to use meat as a garnish or flavoring in a meal, rather than as a major portion. Fill up on vegetables and complex carbohydrates (whole grains, rice, corn, beans), and use meat to enrich your meals. Beans are an excellent and nutritious source of protein and contain many important vitamins and minerals.

Coffee, Alcohol, and Cigarette Smoking

Here's yet another good reason to either give up coffee and alcohol or use them in moderation. And do I need to tell you how important it is to stop smoking now! (It's never too late to reap the benefits of quitting smoking.) Each of these substances creates a negative calcium balance in the body. Substances called phytates and oxylates bind with calcium in the large intestine and form insoluble salts, rendering the calcium useless. The bone mineral content of smokers is 15-30% lower in women and 10-20% lower in men. Cigarette smoking is a significant risk factor for osteoporosis. Twice as many women with osteoporosis smoke as compared with women who do not have osteoporosis.

Aluminum

Don't take antacids with aluminum and don't use aluminum cooking pots. It has been shown that small amounts of aluminum-containing antacids increase the urinary and fecal excretion of calcium, inhibit absorption of fluoride, and inhibit absorption of phosphorus, creating a negative calcium balance. The calcium is excreted instead of being utilized.

Diuretics

Diuretics are medicines that cause water loss in the body. Along with the water you lose minerals, most notably calcium, magnesium and potassium. They are commonly used in conventional medicine to treat high blood pressure, swelling of the lower legs, and congestive heart disease. People who use diuretics have a higher risk of fracture. If you need to use a diuretic, try a gentle herbal one such as dandelion root in a tincture, capsule or tea.

Fluoride

What's so bad about fluoride? You probably think it just builds good teeth. There is good, solid scientific evidence that fluoridated drinking water increases your risk of hip fractures by 20-40%. So much fluoride has been put into our water and toothpaste over the past 30 years that levels in our water, food and drink are very high. While eating a normal diet the average person exceeds the recommended dose. There is also evidence that ingesting high levels of fluoride can cause abnormal bone growth. Please avoid fluoride, in all forms including toothpastes and mouthwashes.

You can be thankful if you live in an unfluoridated community because it's not easy to get rid of fluoride in your tap water. Distillation and reverse osmosis are the only two reliable methods for removing fluoride. Other water filters may work at eliminating fluoride for a short period of time, but fluoride binds so strongly and quickly to filter materials such as charcoal, that the binding sites become fully occupied after a short time. If you are at a high risk for osteoporosis, I recommend you spend the money on a water filter that removes fluoride.

High Dose Cortisone

A well known risk for osteoporosis is long term treatment with the synthetic cortisones such as Prednisone. Since the cortisones (or more properly, glucocorticoids) are closely related to progesterone in their molecular structure, the theory is that they compete for the same receptor sites on bone-building cells. However, while progesterone gives bones the message to grow, the cortisones give bones the message to stop growing. If you must be on a cortisone, talk to your doctor about using a low dose natural cortisone called hydrocortisone rather than the synthetic cortisones.

Bone Mineral Density (BMD) Testing

One of the best ways to find out if you're losing bone is to have someone measure your height, and then check it every six months or so. If you start losing height, that's a sure sign that you're losing bone on your spine. I recommend that women at risk for osteoporosis get a bone mineral density measurement as they're going into menopause. That way you'll have a baseline with which to compare later bone density tests, to measure your progress. The safest and most accurate ways to measure bone are with Photon Absorptiometry, and Dual Energy X-ray Absorbtiometry (DEXA), which is 96-98% accurate and uses very low-dose x-rays. I don't recommend CAT scans, as they use too high a level of X-rays. A newer technique for measuring bone loss is called "Urinary Excretion of Pyridinium," (Bone Resorption Test) which measures a substance in the urine that can indicate rapid bone turnover rate.

OSTEOPOROSIS PREVENTION AND REVERSAL

Lifestyle

1) If you're smoking, stop now.

2) Reduce or eliminate coffee and alcohol. (No more than one cup of coffee and one alcohol drink per day. If you are at a high risk I advise elimination.)

3) Get some weight bearing exercise at least one hour three times a week or 20 minutes daily.

4) Avoid antacids, and hydrochloric acid (H2) blockers such as Tagamet, Zantac and Pepcid.

5) Avoid prescription drugs that cause bone loss, such as diuretics and synthetic cortisones.

6) If you are over the age of 50, avoid fluoride in toothpastes, mouthwash and tap water. If you live in a fluoridated community and are at a high risk for osteoporosis, invest in a water filter that eliminates fluoride.

Osteoporosis and Surgical Menopause

Osteoporosis is a disease that causes the loss of bone mass. After surgical menopause (removal of the ovaries) bone mass is lost at a rate of one percent per year. After natural menopause the decrease is more gradual, but it is steady. In fact, a woman begins to experience demineralization of her bones beginning in her early thirties. Twenty-five percent of American women today get osteoporosis, which is a crippling, degenerative disease, and once the bone mass is lost it is, practically speaking, lost forever. This is a case where prevention is essential.1

How HRT Can Help

In June 2001, an article that appeared in The Journal of the American Medical Association7 (JAMA) received a lot of media attention in that it suggested (in the media's take on the report, at least) that HRT does not reduce osteoporosis in menopausal women. The American College of Obstetricians and Gynecologists, however, take the position that: "The authors [of the JAMA study] conclude that among randomized trials of HRT there was astatistically significant reduction in nonvertebral fractures when women started therapy before age 60...Some press interpretations of the implications of this report -- concluding that HRT has no value in preventing osteoporosis or reducing nonvertebral fractures -- are inconsistent with our reading of the study, and have generated unnecessary concern and confusion among both patients and physicians. The American College of Obstetricians and Gynecologists (ACOG) is reviewing all relevant information and any future recommendations by ACOG will be based on analysis of the available data. Until such a detailed review of this meta-analysis can be done, ACOG does not recommend, based upon existing information, that women on HRT change their current therapeutic regimen."8 Basically what this means is that, according to the experts at ACOG, the jury isn't out on this particular study and women who are taking HRT to prevent osteoporosis should continue to do so. Which probably is good advice.

One of the most common reasons that is given for women to start on estrogen replacement therapy (ERT) is to protect against osteoporosis, and customary contemporary medicine currently advocates treating hysterectomized women with unopposed estrogen (estrogen without progesterone). The reason given is that the lack of estrogen stimulates certain bone cells (osteoclasts) to actually absorb the healthy bone (resorption). New evidence suggests, however, that when using ERT alone, the protection against bone resorption fades and after about 5 years or so, bone loss continues at the same rate as in women not using estrogen. The more important factor in osteoporosis is the lack of progesterone, which causes a decrease in new bone formation.2

Research suggests that a combination of estrogen/progesterone both prevents bone loss (estrogen's effect) and increases bone formation (progesterone).3, 4

Simply put, estrogen provides short-term protection against bone deterioration, while progesterone actually stimulates new bone development and can reverse osteoporosis.

How Diet Can Help

""How to guard against osteoporosis is a subject for debate. The American Dairy Council advises drinking four glasses of milk a day, and others suggest mineral supplements and special foods. There is no guarantee that a specific regimen will completely prevent osteoporosis in every women, but it is clear that certain things really do help, while others are not so beneficial. Even if you already have osteoporosis, improvement in lifestyle can help alleviate symptoms.

For best calcium absorption, it is ideal to eat calcium-rich foods that contain a calcium/phosphorus ratio of 2:1. A good calcium/phosphorus ratio is found in leafy green vegetables and sea vegetables. The ratio in milk is 1:1, not a very good sign for calcium absorption and a measurable indicator that milk is not exactly the ideal "backbone of every woman's diet."

Not only are milk and dairy products, in general, less than perfect food for preventing osteoporosis, it is becoming clear that there are other problems with milk that could be considered side effects when a woman consumes dairy food in order to prevent osteoporosis. There appears to be a very real link between dairy food consumption and breast cysts, vaginal discharge, and sinusitis.

There are other dietary considerations with respect to calcium that are worth noting. Because meat and soft drinks are very high in phosphorus, they also interfere with the body's ability to use the calcium it takes in. High fat intake (the average American diet is 40 percent fat) also blocks calcium absorption. By eliminating meat, soft drinks, and excess fat, some studies show that a woman can effectively reduce her calcium requirement to much less than the current recommended daily requirement for that mineral. This does not necessarily mean that you can cut way back on calcium-rich foods as you begin to eat a healthier diet. Rather, if there is anything to be learned from menopause it is that the body changes slowly and deliberately, albeit wondrously! Your body is unique and grows at its own pace and in its own way. These standardized percentages are rough guidelines. There is no substitute for listening to yourself and seeking professional help if you think you need it.

Scientific knowledge of all aspects of osteoporosis is currently limited and there are no absolute answers. Despite that, we can take positive steps to increase our intake and absorption of calcium and protect our skeletal structure:

We can base our diet on whole grains and legumes and supplement with sea vegetables and greens daily, while carefully limiting or eliminating rich protein foods such as beef, chicken, eggs, and dairy products.

If opportunities to eat whole grains, beans, and vegetables is limited, you can take a mineral supplement containing 500 mg. calcium/magnesium. While this approach may be helpful, particularly on a limited basis, bear in mind that a mineral supplement has unexplored effects on an individual's body chemistry. That's why a supplement that includes all the trace minerals usually found in combination with calcium in nature is recommended.

Exercise! Three times a week for twenty minutes or more is best. Choose an exercise that stresses the long bones of the body because this sets up a mini-electrical current in the bone, helping to draw the calcium in. Swimming, for example, does not have this beneficial effect on calcium absorption even though it offers good aerobic exercise.

Do not smoke.

Enjoy regular, moderate exposure to sunlight [or take a supplement that contains Vitamin D, which is necessary for your body to absorb calcium]."1

How to Determine Your Bone Health

There are a number of simple tests your doctor can perform to determine both your current bone health and the rate at which your bones are responding to HRT (or the lack of it).

Bone Mineral Density Scans

These tests determine the current state of your bones--specifically, whether you are at risk for osteoporosis or currently have it. In conjunction with bone resorption tests (see following section), these tests will let you know if you are losing bone mass and will help your doctor prescribe or modify your HRT regimen to treat your condition.

Dual Energy X-Ray Absorptiometry (DEXA): The gold-standard of bone density tests. X-ray test that measures bone density in the hip, spine, and forearm, and then compares your results to the bone of a woman at peak bone mass, which normally occurs between the ages of 25 & 35 years of age. (Note that after 35, most women being losing bone mass at a rate of up to 1 percent per year until menopause, at which point bone mass is lost at around 2-5 percent per year for 1- years, then back to the 1 percent rate). 5

Ultrasonographic Bone Densitometry: Transmits high-frequency sound waves through the heel bone to determine bone density. Does not involve x-rays.

Dpd Test

The Dpd (deoxypyridinoline) test measures your present rate of bone resorption, or in other words, the rate at which your bones are currently breaking down. This is a simple urine test that is best done in the morning, since bones remodel at a higher rate when you are sleeping than when you are active. This test lets your doctor assess whether you need HRT and, if you are on HRT, whether the therapy is working. Tests can be repeated at 3-, 6-, or 12-month intervals and your HRT regimen adjusted to decrease bone loss. Note that a score of less than 6.5 nM/mM is within normal range, based on results for healthy men and premenopausal, non-pregnant women. 6

As with any therapy, consult with your physician BEFORE you begin any treatment.

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1Christiane Northrup, M.D. and Susan Stayman Lowy. The Challenge of Menopause: Self-awareness and a whole foods diet can smooth the transition. Voices of Women http://www.voiceofwomen.com/articles/menopauseart.html

2Lee, John. What Your Doctor May Not Tell You About Menopause: The Breakthrough Book on Natural Progesterone. Warner: New York. 1996.

3Prior JC, Vigna YM, Wark JD, Eyre DR, Lentle BC, Li DK, Ebeling PR, Atley L. Premenopausal ovariectomy-related bone loss: a randomized, double-blind, one-year trial of conjugated estrogen or medroxyprogesterone acetate. J Bone Miner Res 1997 Nov;12(11):1851-63.

4Prior JC. Progesterone as a bone-trophic hormone. Endocr Rev 1990 May;11(2):386-98.

5Ahlgrimm, Marla and Kells, John. The HRT Solution. Avery: New York. 1999. p. 93-94.

6Ibid. p. 94-95.

7D.J. Torgerson, PhD. and S.E.M. Bell-Syer, MSc. Hormone Replacement Therapy and Prevention of Nonvertebral Fractures. JAMA 2001 June 13;Vol 285, No 22.

8Statement of The American College of Obstetricians and Gynecologists on the JAMA article, "Hormone Replacement Therapy and Prevention of Nonvertebral Fractures: A Meta-Analysis of Randomized Trials". ACOG NEWS RELEASE June 14, 2001.

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Copyright © 2001 SurgiMenopause.Com

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ESTROGEN VS. PROGESTERONE

Osteoporosis, or bone loss, in women has led doctors to routinely prescribe estrogen supplementation, but is there really any benefit in this? In truth, there is no evidence that this estrogen therapy does much to relieve osteoporosis at all. Yet, this remains the standard medical approach for osteoporosis.

Dr. John Lee suggests that osteoporosis in women as they age is due to decreasing levels of progesterone, NOT estrogen.

Jerilyn C. Prior, M.D., and her associates also found evidence of progesterone's possible role in countering osteoporosis in a study of sixty-six premenopausal women between twenty-one and forty-one years of age. All these women were long-distance marathon runners. It was observed after twelve months that:

The average spinal bone density decreased by about 2%... However, women who developed ovulation disturbances during the study lost 4.2% of their bone mass in one year. While there was no correlation between the rate of bone losses and serum levels of estrogen, there was a close relationship betwen indicators of progesterone status and bone loss.

The presence or absence of estrogen supplements had no discernible effect on osteoporosis benefits... Progesterone deficiency rather than estrogen deficiency is a major factor in the pathogenesis of menopausal osteoporosis. (Other factors promoting osteoporosis are excess protein intake, lack of exercise, cigarette smoking, and inadequate vitamins A, D, and C.)

Although there are many forms and ways to take natural progesterone, Dr. Lee promotes the transdermal method. By carefully observing his patients over the course of fifteen years, he proved the effectiveness of transdermal progesterone cream. His work confirmed its safety and its remarkable benefits to his osteoporotic patients who had a history of cancer of the uterus or breast and to those who had diabetes, vascular disorders, and other conditions.

Dr. Lee had hoped that the progesterone would strengthen his patients' bones. To his surprise, it did; their bone mineral density tests showed progressive improvement and the number of his patients suffering osteoporotic fracture dropped to zero.

Dr. Lee points out that the "conventional treatment of osteopososis with estrogen, with or without supplemnetal calcuim and vitamin D, tends to delay bone mass loss, but not reverse it." His investigation into using transdermal progesterone cream instead of a synthetic estrogen replacemnt treatment demonstrates that "osteoporosis subsided, musculoskeletal strength and mobility increased, and monthly vaginal bleeding did not occur." Most striking were the results of the dual-photon densitometry tests: "a 5-10% increase in bone mineral density; and this was even evident to the women who were 25 years after menopause."

After years of researching transdermal progesterone supplementation, Dr. Lee observed in his patients "a progressive increase in bone mineral density and definite clinical improvement including fracture prevention..." He concluded that "osteoporosis reversal is a clinical reality using a natural form of progesterone derived from yams that is safe, uncomplicated and inexpensive."

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HORMONE HERESY:

Estrogen's Deadly Truth, Part I

by Sherrill Sellman

Extracted from Nexus Magazine, Volume 3, #4 (June - July '96)

Women are misinformed about their hormones, to the detriment of their health, while drug companiesreap huge profits at their expense.

For over 300 years, beginning in the 13th century and continuing well into the 16th century, the Inquisition was a reign of terror for the vast majority of people living throughout Europe and Scandinavia. The political, economic and religious forces of that time joined together to consolidate their power by eliminating those whom they perceived as impeding their ultimate objectives.

The unfortunate target of their efforts were the keepers of the healing arts and the ancient spiritual and cultural wisdoms. Historians debate the exact toll of such a hellish time -whether it was several hundreds of thousands or as many as nine million people - but what is undebatable is that the vast majority of the victims were women. In fact, the Inquisition is nowregarded as a period of genocide against women, which successfully divested women of their power, self-respect, wealth, healing arts, and prominence and influence in their communities.

The Inquisition guaranteed that the Church fathers were the indisputable spiritual authorities. It was also successful in enshrining medical knowledge securely in the realm of men, since the Inquisition decreed that only trained medical doctorscould now practice the healing arts and, needless to say, medical schools were barred to women (for that matter, so was anyform of education).

What a relief that such a violent and misogynous era ended long ago. Or did it? Unfortunately, it appears that some traditions linger on. Women of today are still prey to vast political and economic interests, with dire consequences to their health, financial independence and personal power. Perhaps the Inquisition didn't end at all but just took on a more subtle and devious form.

Women are certainly big business to the medical and pharmaceutical interests. According to John Archer, author of BadMedicine, about 600,000 hysterectomies are performed every year in the USA, and about 45,000 in Australia. a In 1994, itwas estimated that 45,000 Australian women were taking hormone replacement therapy (HRT). (2) Many women are presently encouraged to remain on HRT for the rest of their post-menopausal lives.

According to Dr. Stanley West, noted infertility specialist, chief of reproductive endocrinology at St. Vincent's Hospital, New York, and author of The Hysterectomy Hoax, about 90 per cent of all hysterectomies are unnecessary. Gynecologicalconsultants to Ralph Nader's Public Health Research Group reached a similar conclusion in 1991 in their book, Women'sHealth Alert. According to Dr. West, the only 100 percent appropriate reason for performing an hysterectomy is for treatingcancer of the reproductive organs. (3) However, hysterectomies are all too frequently offered as treatment for a variety of conditions including endometriosis, fibroids, ovarian cysts, pelvic inflammatory disease and uterine prolapse.

It is no accident that gynecologists happen to be the highest earners of all specialists. Throughout their lives, women areencouraged to be subjected continuously to various medical treatments and procedures. Natural female functions, from menstruation through childbirth and into menopause, are taken over by medical and pharmaceutical interventions. Barraged by misinformation, myths, propaganda and, in some cases, downright lies, it's no wonder that so many women are thoroughly confused about matters relating to their own bodies and their health.

The History of Hormone Replacement

TherapyPerhaps there's no topic of greater confusion to women than the highly publicized introduction of HRT for the menopausal woman. It is touted as the best thing for liberating women since the discovery of oral contraceptives - even though the statistics now show that the wide use of the Pill has given rise to health hazards such as breast cancer, high blood pressure and cardiovascular disease on a scale previously unknown in medicine. (4)

Investigation into the theory of hormone replacement goes al! the way back to the 1930s with the research of Dr. Serge Voronoff. His research involved implanting fresh monkey's testicles into men's scrotums, with limited effectiveness. Offshoots of his research led to the grafting of monkey ovaries in women, with rather dire consequences. After several fatalities (to both monkeys and women), the search was redirected to the use of synthetic estrogen. With the advent of World War II, research was put on hold.

Menopause didn't really come into vogue as a topic of concern for the medical profession until the 1960s. In 1966 a New York gynecologist, Dr. Robert Wilson, wrote a best seller called Feminine Forever, extolling the virtues of estrogen replacement to save women from the 'tragedy of menopause which often destroys her character as well as her health.' His book sold over 100,000 copies in the first year. Wilson energetically promoted menopause as a condition of 'living decay.' According to him,estrogen replacement was a kind of long sought after youth pill that would save poor, fading women from the horrors of age. He popularized the erroneous belief that menopause is a deficiency disease.

Women's magazines eagerly seized upon his ideas and extensively promoted his concepts. This pleased Wilson no end, sincehe bad earlier set up The Wilson Foundation for the sole purpose of promoting the use of estrogen drugs. The pharmaceutical industry generously contributed over US$1.3 million to his Foundation. Each year he received funds from such companies as Searle, Wyeth-Ayerst Laboratories and Upjohn which made hormone products that Wilson claimed were effective in treating and preventing menopause. Pharmaceutical companies jumped on the bandwagon with aggressive promotions and advertising campaigns. His message hit a receptive chord: mid-life women need hormone drugs to be rescued from the inevitable horrorsand decrepitude of this terrible deficiency disease called menopause.

Wilson pioneered the use of unopposed estrogen. However, there had been no formal assessment of the safety of estrogen therapy or its long term effects. Unopposed estrogen went out of vogue when it became obviously apparent that it shortened the lifetime of its users. In 1975, The New England Journal of Medicine examined the rates of endometrial cancer for estrogen consumers, concluding that the risk was seven and a half times greater for estrogen users. Women who had used estrogen for seven years or longer were 14 times more likely to develop cancer. (5)

As the popularity of unopposed estrogen therapy waned, new approaches were sought. The focus was also directed away from the false claims of preserving feminine beauty and youthfulness and towards more urgent health matters. The pharmaceutical industry resurrected estrogen replacement therapy with the new 'safe' hormone replacement therapy - a combination of synthetic progesterone and estrogen which would supposedly protect menopausal women not only from cardiovascular diseasebut also from the ravages of osteoporosis.

While the so-called 'experts' on women's health are reassuring women that there are no, or at least only very minor, unpleasant side effects, Dr. Lynette J. Dumble, Senior Research Fellow at the University of Melbourne's Department ofSurgery at the Royal Melbourne Hospital, believes that 'the sole basis of HRT is to create a commercial market that is highly profitable for the pharmaceutical companies and doctors. The supposed benefits of HRT are totally unproven.' She believesthat HRT not only exacerbates the presenting health problems but also contributes to the acceleration of the aging process of women. It either hastens the onset of other medical conditions or worsens the existing ones.

This perspective seems to he validated by the recent findings from a landmark study, published in The New England Journal of Medicine in 1995, involving 121,700 women, which revealed startling effects from HRT. It warned that women who used HRT to offset the symptoms of menopause also increased their chance of developing breast cancer by 30 to 40 per cent by taking the hormone for more than five years. In women aged between 60 and 64, the risk of breast cancer rose to 70 percent after five years of HRT. Finally, the study concluded that women using HRT were 45 per cent more likely to die from breast cancer than those who chose not to use HRT or used it for less than five years. (6)

According to Leslie Kenton, author of Passage to Power, 'everybody who is anybody will tell you that menopause is an estrogen-deficiency disease and that you will need to take more estrogen as you approach mid-life, What may surprise you is this: not only is most of such commonly given advice on menopause wrong, a great deal of it can he positively dangerous.'

Fortunately there is another side to the hormone story - a perspective that not only can assist women of all ages to attain greater health hut also to reclaim a greater sense of power, responsibility and dignity in their lives.

A Brief Gynecological Tour of a Woman's Body

In order to understand the HRT debate, it is important, first, to have a rudimentary knowledge of a woman's cyclic nature.

Until recently, doctors thought that menopause began when all the eggs in the ovaries had been used up. However, recent work has shown that menopause is probably not triggered by the ovaries but by the brain. It seems that both puberty and menopause are brain-driven events.

Menstruation depends on a complex network of hormonal communications between the ovary, the hypothalamus and the pituitary gland in the brain. The hypothalamus secretes gonadotropin releasing hormone (GnRH) which triggers the production of follicle stimulating hormone (FSH) by the pituitary gland. Tbe FSH then stimulates the growth of the eggfollicles (a small excretory sac or gland) in the ovaries to trigger ovulation. As the egg follicles grow, estrogen is manufactured and released into the blood.

This chain reaction is not just one way. Estradiol, one of the ovarian estrogens in the bloodstream, also acts on the hypothalamus causing a change in GnRH. Next, this altered hormone stimulates the pituitary to produce luteinising hormone (LH) which causes the egg follicles to burst and the ovum to be released. After the egg is expelled, progesterone is also manufactured by the collapsed egg follicle which develops into the corpus luteum.

All the hormones released during the menstrual cycle are secreted not in a constant, steady way but at dramatically different rates during different parts of the 28 day cycle.

For the first eight to 11 days of the menstrual cycle, a woman's ovaries make lots of estrogen. Estrogen prepares the follicles for the release of one of the eggs. It is estrogen which proliferates the changes that take place at puberty: the growth of breasts, the development of the reproductive system and the shape of a woman's body.

The rate of estrogen secretion begins to fall off on about day 13, one day before ovulation occurs. As estrogen falls, progesterone begins to rise, stimulating very rapid growth of the follicle. Beginning with this secretion of progesterone, ovulation occurs too. After the egg has been released from the follicle (known as the luteal stage of a woman's cycle), the follicle begins to change, enlarging and becoming a unique organ known as the corpus luteum. Progesterone is secreted fromthe corpus luteum, this tiny organ with a huge capacity for hormone production. The surge of progesterone at the time ofovulation is the source of libido - not estrogen, as, is commonly believed.

After 10 or 12 days, if fertilization does not occur, ovarian production of progesterone falls dramatically. It is this sudden decline in progesterone levels that triggers the shedding of the secretory endometrium (the menses), leading to a renewal ofthe entire menstrual cycle.

Ovarian estrogen and progesterone stimulate the growth of the endometrium, or lining of the uterus, in preparation forfertilization. Estrogen proliferates the growth of endometrial tissue, and progesterone facilitates the secretory lining of the uterus so the fertilized egg can implant successfully. Adequate progesterone, therefore, is the hormone most essential to the survival of the fertilized egg and the fetus.

At around 40 years of age, the interaction between hormones alters, eventually leading to menopause. It is still not clear bow. Menopause may start with changes in the hypothalamus and the pituitary gland rather than in the ovaries. Scientists have conducted experiments where young mice have bad their ovaries replaced with those from aged animals no longer capable ofreproducing. The young mice can mate and give birth. This shows that old ovaries placed in a young environment are capable of responding. On the other baud, when young ovaries are put into old mice, these mice cannot reproduce. (7)

Whatever the mechanism triggering menopause, as fewer egg follicles are stimulated, the amount of estrogen and progesterone being produced by the ovaries declines although other hormones continue to be produced. By no means do theovaries shrivel up and cease functioning, as is popularly believed. With the reduction of these hormones, menstruation becomes scantier and erratic and eventually ceases.

However, other body sites such as the adrenal glands, skin, muscle, brain, pineal gland, hair follicles and body fat are capable of making these same hormones, enabling the female body to make healthy adjustments in hormonal balance after menopause- provided a woman has taken good care of herself during the pre-menopausal years with proper lifestyle, diet and attention to mental and emotional health.

Menopausal women have the opportunity to enter this phase of life empowered in their wisdom and creativity as neverbefore. They have access to profound inner knowing. The renowned sociologist Margaret Mead said, 'There is nothing more powerful than a menopausal woman with zest.' In many cultures around the world, menopause is a transition and an initiation into the fulfillment of a woman's power, totally symptom-free. She is held in the highest regard in her community as a wise, respected elder.

The Myth of Estrogen and Synthetic Progestins

The earlier research that led to the synthesis of estrogen made possible the development of the oral contraceptive by 1960. With consent of the US Food and Drug Administration (FDA), the Pill was widely marketed as an effective, convenient method of birth control. True sexual liberation for women was at band at last.

However the entire basis for the FDA's consent was the result of clinical studies conducted on 132 Puerto Rican women who bad take; the Pill for one year or longer. Never mind the fact that there were five women who died during the study without any investigation into the cause of their deaths.)

By the mid-1970s the death toll of women from heart attacks and strokes began to attract public notice. A newer, supposedly safer Pill was then created with a lower dose of estrogen. But, in fact, there has never been any valid scientific proof that thePill is safe - nor, for that matter, that any of the other forms of contraception presently available are safe. Women are only now discovering the price they have been paying for their sexual freedom: by altering their hormonal balance, many varied and devastating emotional and physiological dysfunctions have been created.

It is now 35 years on from the introduction of oral contraception and there are presently about 60 million women worldwide who are in effect 'trial-ing' the Pill. Its safety and long term effects have still not been established conclusively. It is interesting to not:, however, that it has produced a wide assortment of adverse effects and side effects and has a significant link to breast cancer, high blood pressure and, in particular, cardiovascular disease -the major cause of female deaths in Australia. In 1992, 27, 833 women died from heart disease and strokes, compared to 2,438 from breast cancer. (9) Is this merely a coincidence, or do these statistics indicate, perhaps, the harmful side effects of tampering with hormones?

While proclaimed also as the primary missing ingredient for the menopausal woman, estrogen is strongly recommended by the medical and pharmaceutical industries for the prevention of cardiovascular disease and osteoporosis. Just about any doctor's surgery you walk into these days will warn women of the inherent risks of going through menopause and, for thatmatter, the post-menopausal years without the protection of estrogen. Women are further reminded, once again, that menopause is a deficiency disease, which supposedly means that they are lacking estrogen and therefore must have supplemental doses to maintain their health.

As Dr. Lynette Dumhle has noted, 'Broadly speaking, cardiovascular prevention in women has overwhelmingly focused on hormone replacement. Yet, as Elizabeth Barrett-Connor emphasizes, the Big Trial, the Coronary Drug Project of 1973 that included two estrogen regimens, was conducted in men. As part of the Big Trial design, estrogen doses extravagantly in excess of physiological levels were deliberately administered to men in order to induce gynaecomastia [enlargement of male breasts] as an indicator of successful feminisation. This resulted in thrombosis and impotence and ultimately led to research failurebecause of treatment discontinuations amongst the study's participants.' (10)

According to medical practitioner, independent researcher and author Dr. John Lee, the one notable study (known as the Boston Health Study, conducted with a large sampling of nurses) which formed the entire basis of the positive estrogen-cardiovascular link, was radically flawed. Although there is ample evidence from numerous other studies showing that, indeed, the opposite is true - i.e., estrogen is a significant factor in creating heart disease - these findings have been virtually ignored in the frenzy for profits. He goes on to say that the pharmaceutical advertisements also neglected to mention the fact that stroke death incidence from that study was 50 per cent higher among the estrogen users.

Dr. Lee has compiled a list of side effects and physiological impairments which result from taking estrogen. They include increased risk of endometrial cancer, increased body fat, salt and fluid retention, depression and headaches, impaired blood sugar control (hypoglycemia), loss of zinc and retention of copper, reduced oxygen levels in all cells, thickened bile and promoted gall bladder disease, increased likelihood of breast fibrocysts and uterine fibroids, interference with thyroid activity, decreased sex drive, excessive blood-clotting, reduced vascular tone, endometriosis, uterine cramping, infertility, and restraint of osteoclast function.

With so many side effects and dangerous complications, a woman must think very carefully about the HRT decision. Unfortunately, most doctors will tell her that there is no other alternative. While certainly most doctors are well-meaning andsincerely concerned about their patients, their primary source of education and product information comes directly from the pharmaceutical companies. Since most women also lack essential education and understanding about their options, menopause can be perceived as a rather frightening and perilous time.

Enter Natural Progesterone

For the past 15 years, Dr. Lee has conducted independent research into a natural, plant derived form of progesterone. His non-pharmaceutically-funded research presents a much broader understanding of a woman's hormonal options and offers a totally safe, effective alternative that is free of all side effects. He has found that this natural hormone - used in conjunction with a good diet and lifestyle changes - is capable of eliminating much of the suffering associated both with premenstrual syndrome (PMS) and menopause. Thousands of women in the Western world now use natural progesterone - generally in theform of a non-prescription cream which is rubbed into the body. They claim that they not only have relief from female symptoms but experience increased vitality, better skin and renewed emotional balance.

Natural progesterone seems to have been totally overlooked by medical science while the erroneous focus has been on estrogen. Considering that it is non-patentable and inexpensive, it not surprising that this is so. It is important, however, to have a much greater understanding and appreciation for this remarkable hormone.

As was previously mentioned, it is progesterone that is responsible for maintaining the secretory endometrium which is necessary for the survival of the embryo as well as the developing fetus throughout gestation. It is little realized, however, that progesterone is the mother of all hormones. Progesterone is the important precursor in the biosynthesis of adrenalcorticosteroids (hormones that protect against stress) and of all sex hormones (testosterone and estrogen). This means that progesterone has the capacity to be turned into other hormones further down the pathways as and when the body needs them. The point needs to be emphasized that estrogen and testosterone are end metabolic products made from progesterone.Without adequate progesterone, estrogen and testosterone will not be sufficiently available to the body-. Besides being a precursor to sex hormones, progesterone also facilitates many other important, intrinsic physiological functions (which will be discussed later).

The Estrogen Dominance Effect

Female problems seem to be on the rise. Between 40 and 60 per cent of all women in the West suffer from PMS. In addition,women also suffer from a plethora of symptoms, some menopausal and others not. Something quite alarming certainly seemsto he happening to women. There is indication that proper hormonal balance necessary for a woman's body to function healthily is being interfered with by a number of factors. Research has revealed that a good portion of women in their 30s(and some even younger), long before the onset of menopause, on occasion will not ovulate during their menstrual month. (11) Without ovulation, no corpus luteum results and no progesterone is made. A progesterone deficiency ensues.

Several problems can result from this deficiency, One is the month long presence of unopposed estrogen with all its attendant side effects, as already mentioned. Another is the generally unrecognized problem of progesterone's role in osteoporosis. Contemporary medicine is still unaware that progesterone stimulates osteoblast-mediated new bone formation. Actually, it is progesterone that stimulates new bone tissue and is capable of reversing osteoporosis at any age. Lack of progesterone meansthat new osteoblasts are not created and osteoporosis can arise. (12) A third major problem results from the interrelationship between progesterone loss and stress. Stress combined with a bad diet can induce anovulatory cycles. The consequent lack of progesterone interferes with the production of the stress-combating hormones, exacerbating stress conditions that give rise tofurther anovulatory cycles. And so the vicious cycle continues.

Another major factor contributing to this imbalance between estrogen and progesterone is environmental in nature. We in the industrialized world now live immersed in a rising sea of petrochemical derivatives. They are in our air, food and water.These chemicals include pesticides and herbicides (such as DDT, dieldrin, beptacblor, etc.) as well as various plastics (polvcarbonated plastics found in babies bottles and water jugs) and PCBs. These estrogen-mimics are highly fat-soluble, notbiodegradable or well excreted, and accumulate in fat tissue of animals and humans. These chemicals have an uncanny ability to mimic natural estrogen. They are given the name 'xeno-estrogens' since, although they are foreign chemicals, they are taken up by the estrogen receptor sites in the body, seriously interfering with natural biochemical changes.

Mounting research is now revealing an alarming situation worldwide created by the inundation of these hormone-mimics. In a recently released book, Our Stolen Future, authors Theo Colburn of the World Wildlife Fund, Dianne Dumanoski of TheBoston Globe and John Peterson Meyers, a zoologist, have identified 51 hormone mimics, each able to unleash a torrent ofeffects such as reduced sperm production, cell division and sculpting of the developing brain. These mimics are not only linked to the recent discovery that human sperm counts worldwide have plunged by 50 per cent between 1938 and 1990 but also to genital deformities, breast, prostate and testicular cancer, and neurological disorders. (10)

Dr. Lee has discovered a consistent theme running through women's complaints of the distressing and often debilitating symptoms of PMS, peri-menopause and menopause: too much estrogen, or, as be has termed it, 'estrogen dominance'.

Now instead of estrogen playing its essential role within the well balanced symphony of steroid hormones in a woman's body, it has begun to overshadow the other players, creating biochemical dissonance. The last thing in the world a woman's bodyneeds is more estrogen - either in the form of contraceptives or HRT. Then, when the estrogen-dominant symptoms appear, guess what is prescribed? More estrogen. The delicate natural estrogen/progesterone balance is radically altered due to too much estrogen. Progesterone deficiency is then exacerbated even more.

Dr. Lee has been able to balance the estrogen-dominance effect through the use of transdermal natural progesterone cream. Natural progesterone, a cholesterol derivative, is made from wild Mexican yams or soybeans whose active ingredients are an exact molecular match of the body's own progesterone. It is interesting to note that in countries in Asia and South America where women eat either the wild yams or soybeans, the term 'hot flush' doesn't even exist in their languages. They also rarely suffer from the host of female problems presently plaguing Western women.

Supplementation with natural progesterone corrects the real problem: progesterone deficiency. Natural progesterone is not known to have any side effects; nor have any toxic levels been found to date. Natural progesterone increases libido, prevents cancer of the womb, protects against iibrocystic breast disease, helps protect against breast cancer, maintains the uterus lining, hydrates and oxygenates the skin, reverses facial hair growth and hair thinning, acts as a natural diuretic, helps eliminate depression and increase a sense of well being, encourages fat burning and the use of stored energy, normalizes blood clotting, and is a precursor to other important stress and sex hormones. Even the two most prevalent menopausalsymptoms - hot flushes and vaginal dryness - quickly disappear with applications of natural progesterone.

There is one other very significant benefit of natural progesterone that deserves a bit more attention. While most people areunder the assumption that estrogen protects against osteoporosis - one of the biggest selling points for which a woman is encouraged to take HBT - this is definitely not the case.

The early studies on which the estrogen protection assumption was based had gross scientific defects. Canadian researcher Jerilyn Prior, chief endocrinologist at the University of British Columbia in Vancouver, and her colleagues, reporting in The New England Journal of Medicine, confirmed that estrogen's role in osteoporosis is only a minor one. In their studies of female athletes, they found that osteoporosis occurs to the degree that they become progesterone-deficient, even though their estrogen levels seem to remain normal. Prior continued her research with non-athletic women. They showed the same results. While both these groups of women were menstruating, they had anovulatory cycles and, therefore, were progesterone-deficient.

Prior then went on to discover that anovulation and a short phase cycle now occur in up to 50 per cent of North American women's menstrual cycles during the final reproductive years. (14) Unfortunately, these major findings went relatively unnoticed in the medical community.

As a result of her extensive review of published scientific evidence in this area, Prior confirmed that it is not estrogen but progesterone which is the bone-trophic hormone; that is, the bone builder. She was even able to identify progesteronereceptor sites on osteoblast cells (bone tissue building cells). Nobody has ever found osteoblast receptors for estrogen. The bottom line is that it is in women with progesterone deficiency that bone loss occurs. (15)

These results were verified by a three year study of 63 post-menopausal women with osteoporosis. Women using transdermal progesterone cream experienced an average 7 to 8 per cent bone mass density increase in the first year, 4 to 5 per cent thesecond year, and 3 to 4 per cent in the third year! Untreated women in this age category typically lose 1.5 per cent bone mass density per year! These results have not been found with any other form of hormone replacement therapy or dietary supplementation. (16)

Dr. Lee believes that the use of natural progesterone in conjunction with dietary and lifestyle change can not only stop osteoporosis but can actually reverse it - even in women aged 70 or more.

At this point, it is important to make the distinction between the natural progesterone that is produced by the body and the synthetic progesterone analogues classified as progestins, such as Provera, Duphaston and Primulut. As you will learn, there is a big difference between the two in their effect in the body, although doctors most often use their names interchangeably. Since natural progesterone is not a patentable product, the pharmaceutical companies have molecularly altered it to produce synthetic progestins commonly used in contraceptives and HBT.

Synthetic progestins, because they are not exact replicas of the body's natural progesterone, unfortunately create a long list of side effects some of which are quite severe. A partial list includes headaches, depression, fluid retention, increased risk of birth defects and early abortion, liver dysfunction, breast tenderness, breakthrough bleeding, acne, hirsutism (hair growth), insomnia, edema, weight changes, pulmonary embolism and premenstrual-like syndrome. (17)

Most importantly, progestins lack the intrinsic physiological benefits of progesterone, thus they cannot function in the major biosynthetic pathways as progesterone does and they disrupt many fundamental processes in the body. Progesterone is anessential hormone that also plays a part in the development of healthy nerve cells and brain and thyroid function. Progestins tend to block the body's ability to produce and utilize natural progesterone to maintain these life promoting functions.

The hormone story is certainly a very complicated one. Up until now, only one version of the story has been available to the majority of Western women, especially Australian women. Serious doubt has been cast on the efficacy and appropriateness of estrogen and progestins in all the forms they take. Women are certainly suffering from a wide variety of female complaints.

What complicates the hormone story is that the prescribed treatments for these complaints are actually making the problem worse. Without understanding the far reaching side effects of estrogen dominance and progestin, doctors are misdiagnosing the cause of these aggravated conditions. Often, other drugs are then prescribed with disastrous side effects, as the spiral of unnecessary medication increases. What is the ultimate toll, not only on a woman's deteriorating health and emotional well being but also on her financial situation, her relationships and her career?

Without adequate knowledge, education and access to natural products, women have been easy prey to the powerful campaigns of the multinational drug companies that have convinced doctors as well as governments of their claims. It isbecoming more evident that women's interests are not always best met through such a biased approach. It is also not unusual for profits to take precedence over health and well being. The last thing a woman needs is to have her natural bodilyfunctions denigrated to deficiency diseases - thus necessitating ongoing medical attention.

It is indeed time for women to take even greater responsibility for their health, their choices and their lifestyles. The greatestweapon against compliance and ignorance is knowledge. It's time to ask poignant questions of your health provider, to demand answers and to be willing to investigate safe, alternative approaches. It is apparent that women will need to participate in educating their doctors about the other choices that exist as well as the ones that they prefer.

Certainly women have it well within their own power not only to find safe, natural and effective ways to heal themselves hutto live long full lives, presenting their vitality, youthfulness and health. Women deserve the right to appreciate themselves and their bodies through all the stages of life. As women find the way to return to a greater balance within themselves, they will know profoundly the truth of what Dr. Deepak Chopra has said about women: 'Feminine wisdom is the intelligence at the heart of creation.'

Effects of Estrogen Dominance

1. When estrogen is not balanced by progesterone, it can produce weight gain, headaches, bad temper, chronic fatigue and loss of interest in sex - all of which are part of the clinically recognized premenstrual syndrome.

2. Not only has it been well established that estrogen dominance encourages the development of breast cancer thanks to estrogen's proliferative actions, it also stimulates breast tissue and can, in time, trigger fibrocystic breast disease - a conditionwhich wanes when natural progesterone is introduced to balance the estrogen.

3. By definition, excess estrogen implies a progesterone deficiency. This, in turn, leads to a decrease in the rate of new bone formation in a woman's body by the osteoblasts - the cells responsible for doing this job. Although most doctors are not yet aware of it, this is the prime cause of osteoporosis.

4. Estrogen dominance increases the risk of fibroids. One of the interesting facts about fibroids - often remarked on bydoctors - is that, regardless of the size, fibroids commonly atrophy once menopause arrives and a woman's ovaries are nolonger making estrogen. Doctors who commonly use progesterone with their patients have discovered that giving a woman natural progesterone will also cause fibroids to atrophy.

5. In estrogen dominant menstruating women where progesterone is not peaking and falling in a normal way each month, the ordered shedding of the womb lining doesn't take place. Menstruation becomes irregular. This condition can usually be corrected by making lifestyle changes and using a natural progesterone product. It is easy to diagnose by having a doctormeasure the level of progesterone in the blood at certain times of the month.

6. Endometrial cancer (cancer of the womb) develops only where there is estrogen dominance or unopposed estrogen. This, too, can be prevented by the use of natural progesterone. The use of the synthetic progestins may also help prevent it, which is why a growing number of doctors no longer give estrogen without combining it with a progesterone drug during HRT. However, all synthetic progestins have side effects.

7. Water logging of the cells and an increase in intercellular sodium, which predispose a woman to high blood pressure or hypertension, frequently occur with estrogen dominance. These can also he side effects of taking synthetic progestogen(progestins]. A natural progesterone cream usually clears it up.

8. The risk of stroke and heart disease is increased dramatically when a woman is estrogen-dominant. (Source: Leslie Kenton, Passage to Power, Random House, UK, 1995)

Anti-aging Benefits of Natural Progesterone

1. Progesterone is a primary precursor in the biosynthesis of the adrenal corticosteroids. Without adequate progesterone, synthesis of the cortisones is impaired and the body turns to alternate pathways. These alternate pathways have masculine-producing side effects such as long facial hairs and thinning of scalp hair. Further impaired corticosteroid production results in a decrease in the ability to handle stress, e.g., surgery, trauma or emotional stress.

2. Many peri- or post-menopausal women with clinical signs of hypothyroidism, such as fatigue, lack of energy, intolerance tocold, are actually suffering from unrecognized estrogen dominance and will benefit from supplementation with natural progesterone.

3. Estrogen and most of the synthetic progestins increase intracellular sodium and water uptake The effect of this is hypertension. Natural progesterone is a natural diuretic and prevents the cell's uptake of sodium and water, thus preventing hypertension.

4. Whereas estrogen impairs homeostatic control of glucose levels, natural progesterone stabilizes them. Thus, natural progesterone can be beneficial to both those with diabetes and those with reactive hypoglycemia. Estrogen should be contraindicated in patients with diabetes.

5. Thinning and wrinkled skin is a sign of lack of hydration in the skin. It is common in peri- and post-menopausal women and is a sure sign of hormone depletion. Transdermal natural progesterone is a skin moisturizer which restores skin hydration.

6. Progesterone serves a role in keeping brain cells healthy. A disorder such as premature senility (Alzheimer's disease) may be, at least in part, another example of disease secondary to progesterone deficiency.

7. Progesterone is essential for the healthy development of the myelin sheath which protects the nerve cells. Low progesteronelevels lead to recurring aches and pains.

8. Progesterone creates and promotes an enhanced sense of emotional well being and psychological self-sufficiency.

9. Progesterone is responsible for enhancing the libido. (Source: John R Lee, M.D., Slowing the Aging Process with Natural Progesterone, BLL Publishing, CA, USA, 1994, p. 14)

End notes:

1. Archer, John, Bad Medicine, Simon & Schuster. Australia. 1995, p. 191.

2. Op. cit., p. 217.

3. Op. cit., p. 192.

4. Op. cit., p 211.

5. Coney, Sandra, The Menopause Industry, Spinifex Press Pty Ltd., Australia, 1991, pp. 164-165.

6. The Sydney Morning Herald, 24 June 1995.

7. Coney, Sandra, op. cit., p. 584.

8. Archer, John, op. cit., p. 210.

9. Archer, John, op. cit., p. 211.

10. (a) Dumble, Lynette J., Ph.D., 'Odds Against Women with Heart Disease', presented at Health Sharing Women'sForum, Royal College of Surgeons, Melbourne, Victoria, Australia, 14 September 1995. (b) Barrett-Cormor, Elizabeth.'Heart Disease in Women', Fertility and Sterility (1994), 62(2):127S-132s.

11. Lee, John R., M.D., Natural Progesterone: The Multiple Role of a Remarkable Hormone, BLL Publishing, California, USA,1993, p. 29.

12. Ibid.

13. Newsweek, 18 March 1996.

14. Kenton, Leslie, Passage to Power, Random House, UK, 1995, pp. 19-20.

15. Ibid.

16. Lee, John R., M.D., 'Osteoporosis Reversal: The Role of Progesterone', International Clinical Nutrition Review (1990),10:384-391.

17. Lee, John R, M.D., Slowing the Aging Process with Natural Progesterone, BLL Publishing, California, USA, 1994, p. 12

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