Hormone Therapy Controversy

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(Berkeley Wellness)

Under the ever-seductive banner of “natural,” a whole new commerce in estrogen has arisen—individualized estrogen (or progesterone) regimens prepared by “compounding” pharmacies. Here's what you need to know.

Estrogen is so widely discussed these days that it’s hard to believe it was discovered less than a century ago, in the 1920s. Its uses were not well understood, and with the benefit of hindsight we see that early research was flawed. From 1938 until 1971 doctors routinely prescribed a form of estrogen called DES (short for diethylstilbestrol) for pregnant women perceived to be at risk for miscarriage. But it turned out that DES did not prevent miscarriages, and long-term results were disastrous: females exposed to DES in the womb were at high risk for rare forms of genital cancer, males for other disorders. In 1971 the FDA put a stop to this use of DES and began tracking down exposed women and their children to offer information and advice.

Then came the boom in hormone therapy—estrogen as a way to stay youthful, according to its enthusiasts, or at least to help prevent heart disease and bone fractures. In 2002, however, a landmark federal study linked hormone therapy (estrogen combined with progestin) to an increased risk of breast cancer, heart attacks, and strokes. Hormone therapy lost its groove, and is now recommended only for short-term use to prevent severe hot flashes and other menopausal symptoms.

Purveyors of “natural” estrogen make the same old claims: that this particular kind of estrogen will keep women healthy and preserve their good looks, sexiness, and mental abilities. These “bio-identical” estrogens, it’s said, are perfectly safe because this is the same estrogen women have in their bodies. A few years ago, however, the FDA warned that these claims about estrogen are unsubstantiated and misleading and ordered seven big pharmacies to stop making and selling these products.

Bottom line

The estrogen in question is synthesized from plant compounds. There is no scientific definition of “bio-identical”—it’s just a marketing term—and no evidence that such estrogen is safer than that from other sources. Taken as a drug at or after menopause, estrogen will not prevent Alzheimer’s or provide any benefits worth the risks that go with its long-term use. It will, as noted though, reduce hot flashes.

Except for the estrogen in your body, there is no such thing as “natural” estrogen. “Natural” should only arouse your suspicion when applied to a hormone that someone is trying to sell you.