589913 Last update: 2023-08-11
Controversies about Menopause (1 of 2)

Always in the context of respect for the physiological norms that need to be restored for optimal heath, it is time to address the sensitive issue of sex hormones after the menopause. Contrary to what most people think, women continue to produce low levels of hormones after their periods have stopped; this minimal secretion should normally continue with any woman in good health.

Let’s take for example the main oestrogen, namely œstradiol: its blood concentration falls by a factor of 10 (to make it simple) once the ovaries stop functioning. However, the sex hormones produced in the adrenal cortex persist and should provide, if the adrenal function is not itself defective, residual levels of female hormones, not only œstradiol but also progesterone.

Contrary to what happened during the reproductive years, women’s hormonal secretions during the menopause don’t fluctuate with the monthly cycle; indeed, it is precisely the cessation of menstruation that characterises this new state. It is now a plateau of low hormonal concentrations but it is certainly not a case of the total disappearance of sex hormones.

It is essential to understand that despite the absence of the monthly cycle, menopausal women should continue to benefit from the many physiological functions of their residual hormone production; in fact, it is essential to their wellbeing.  It is the œstradiol that boosts morale to start the day, while progesterone promotes relaxation and restful sleep. A postmenopausal woman devoid of these physiological sex hormones thus loses her circadian rhythm: never really fit for the day and never really relaxed at night!

I remain shocked by the total lack of interest from the more conventional medical establishment (or should we say more conservative?) in this area.  In Britain for example, the National Health Service (NHS) only expresses the blood level of œstradiol in women of menopausal age as less than the threshold value. To be clear, their laboratories only indicate that the patient has fallen below the values established for premenopausal women. They might confirm menopausal status but they provide no value: they cannot assess the merits of hormone replacement therapy (HRT) for a particular patient.

Let me say it bluntly: HRT suffers from an appalling reputation, especially since the famous WHI (Women’s Health Initiative) study, published in two parts in the Journal of the American Medical Association (JAMA) in 2002 and in 2004. It must be recognized that the explosive results of this study were not surprising… using a hormonal replacement therapy utilising a strong dose of conjugated equine œstrogen (noting that mare œstrogen is much more powerful than human oestrogen) to an artificial progesterone. This involves a high and standardized dosage (which means all women receive the same treatment) combining two hormones foreign to the human body and, more importantly, orally administered. In short, here is everything you need to increase the risk of breast cancer and cardiovascular events.

In my opinion, hormone replacement therapy created and administered in such a way represents a threefold mistake: there is no personalised dosage; it uses artificial hormones (or non-human, which is the same thing); and entails orally administered pills involving the digestive tract and thus directly exposing the patient to potentially carcinogenic effects of oestrogen detoxification in the liver.

By changing nothing, we hang to what we understand, even if it is the bars of our own jail.
- John le Carré, The Russia House 1989

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