GLOBE AND MAIL
Tuesday, July 16, 2002

Menopause and the Hormone Hangover
by Gabor Maté

Let's stop seeking miracle cures for natural processes and embracing treatments before we know their long-term effects, says Dr. Gabor Maté

Recently a large-scale U.S. study on the effects of hormone-replacement therapy (known widely as HRT) for menopause was abruptly terminated three years ahead of schedule. This provides a dramatic illustration of much that is wrong with the current practice of medicine.

Five years into the study's projected eight-year duration, it has become clear that the harm done by the hormone combination significantly outweighs its potential benefits. Contrary to what women have been advised, rather than preventing heart disease, the drugs increase the risk of heart attacks and strokes and also elevate the risk for breast cancer.

While in the short term the hormones are effective and probably safe in reducing specific menopause-related symptoms such as hot flashes, doctors have been under tremendous pressure to prescribe them also as "preventive medicine" for thinning of the bones and for heart disease.

Some years ago, along with hundreds of fellow physicians, I attended an expensive drug-company-sponsored dinner in the ballroom of Vancouver's most elegant hotel. An Australian medical authority imported for the purpose, supported by a cast of local specialists, all but suggested that virtually every woman should be on HRT permanently for the last several decades of life.

It felt almost heretic to whisper, as I did to an acquaintance, that on a gut level it somehow didn't sit right to interfere with natural processes on such a massive scale for what, even then, seemed a paltry few percentage gains of potential benefit.

Many other doctors, not to mention most women, have felt the same way. The use of HRT never did catch on to anywhere near the extent pharmaceutical propaganda would have urged, but millions of women have been given these hormonal medications on incomplete evidence and very shaky assumptions. Some have suffered serious consequences.

It may seem surprising that synthetic analogues of the natural hormones estrogen and progesterone should cause disease. These two major feminine hormones "kick start" the female body toward sexual maturation at puberty and modulate the reproductive cycle until menopause. They help preserve youthful physiological functioning. Why should they become harmful in middle age and beyond?

As always, nature has purposes and means beyond our awareness and does not easily forgive when human science presumes to know better. It is one thing to bring medical science into alignment with nature, quite another to set ourselves up in defiance of it.

No hormone acts in a vacuum. Estrogen and progesterone in puberty and beyond are part of a vast and complex cascade of hormonal activity that involves the brain and other organs, and many other hormones as well. There is a delicate balance and manifold subtle interactions between the myriad hormones secreted by the brain and the ovary and by the adrenal and thyroid glands and related physiological structures.

The biochemistry of sexual maturation and aging do not function in isolation from the immune apparatus, from the cardiovascular organs, or from psychological factors.

Neither in puberty nor in menopause can one or two of the chemical components of this complicated, intricate system be separated with impunity from the rest. Nature teaches over and over again that we may interfere with it only when absolutely necessary, and preferably only for short periods. The HRT debacle is only the latest case of pharmacological enthusiasm running ahead of scientific evidence. Another was the sobering example, less than two years ago, of a "wonder drug" named alosetron for irritable-bowel syndrome (IBS), a condition that affects millions. Leading Canadian authorities eagerly endorsed the drug, despite some early warnings about potential ill effects. The head of the department of medicine at a Canadian university called it "a very exciting breakthrough."

One month later, the U.S. Food and Drug Administration forced the manufacturer to withdraw the drug. Women had been hospitalized with ischemic colitis-bowel inflammation due to the deprivation of blood supply to the intestine. Several required surgery and in at least one case the patient's entire colon had to be removed. There were reports of deaths.

The HRT and alosetron experiences demonstrate the dominance of the agenda of the pharmaceutical industry over medical science. "Successes" are often reported prematurely, while potential harmful effects are sometimes minimized.

Drug companies are the major sources of funds for research, whether at universities or in private laboratories. There are many alternative approaches to symptoms such as hot flashes and to other post-menopausal problems such as osteoporosis, or thinning of the bones, but because they do not necessarily promise to increase drug-company profits, they are unlikely to receive massive research support.

Osteoporosis, for example, is not a natural consequence of aging. It has a genetic basis in a relatively few cases, but for the most part it is a consequence of life factors such as poor diet, smoking, physical passivity and emotional stress. Women who are depressed are much more likely to suffer bone thinning and hip fractures. Depression is associated with chronically high levels of the stress hormone cortisol, which has powerful bone-thinning effects.

One approach to osteoporosis would be to address women's stress issues, emotional states and physical-activity levels. But who will fund such research? And will the medical mind -- narrowly conditioned to think in terms of pharmaceutical solutions -- readily adapt to a more holistic approach?
We may see the HRT study not only as a failure, but also as a challenge calling for a broader, more humane medicine that does not reduce every human problem to simplistic chemical terms.

BACK

Now comes Gabor Maté , an insightful, no-nonsense, and thoroughly compassionate physician who provides an overview of all these perspectives and comes to the marvelously humane conclusion that ADD/ADHD is neither nature (genetics) nor nurture (parenting/environment) but, rather, the result of the collision of a predisposing nature with an ADD-hostile life situation, family, school, or job. How refreshing!

-Thom Hartman, author of ADD: A Different Perception and many other books about ADD