Wednesday Bubble: HRT? Everybody must get kidney-stoned
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Everybody must get stoned? If you are using HRT, this may be the case. Straight out of the headlines of the American Medical Association’s Archives of Internal Medicine: Healthy women who use HRT may be at increased risk of kidney stones.
You hear about them. But what are kidney stones?
Kidney stones are hard masses the develop when crystals separate out from the urine. Many factors interact to form stone and they are influenced by both genetics and the environment. Although they are often prevented by naturally occurring chemicals before they actually form, when they occur, they can cause extreme pain. Over time, they may actually damage the kidneys. And while kidney stones more commonly affect more men than women up to a certain age, by the time a woman reaches 50, this discrepancy balances out, possibly because estrogen may have a protective effect up until this time.
So, if estrogen is good and protective, what goes wrong when you add it back to the mix?
The findings...In the latest analysis of what is now becoming the infamous Women’s Health Initiative Study, researchers evaluated over 10,000 women in natural menopause who had taken estrogen only (Premarin), estrogen plus progestin (Preempro) or placebo. After an average of 5 to 7 years (depending on which agent the women were taking), women taking hormones, either alone or in combination, had a 21% increased risk of developing kidney stones. When the researchers excluded women who stopped using hormones during the actual trial from the analysis, the likelihood of developing kidney stones increased to 39%. Moreover, study researchers were unable to attribute the increased risk to any other factors, including age, ethnicity, BMI, prior use of hormones or intake of coffee or thyroid medication. Writing in Annals, however, they did note that the way that kidneys stone are formed is complex, and that estrogen may play a role in several stages of that formation and requires further study.
According to the researchers, about 5% to 7% of women reaching menopause will develop kidney stones. My friends over at Reuters health, who did an excellent recap of this study, note that in combination with hormone therapy, this risk increases up to 10%, despite that addition of progestin.
In addition to avoiding hormone therapy, the best thing to do to prevent kidney stones is to hydrate! If you have a tendency to form stones, the National Institute of Diabetes and Digestive and Kidney diseases recommends that you drink enough fluids, preferably water, to produce about 2 quarts of urine a day. Changing your diet can help too: some experts recommend limiting dairy and proteins that are high in calcium. The best thing to do, as always, is to do some preliminary research and then contact your health practitioner.
So getting stoned? How about losing the HRT? Another bubble burst for a failed therapy.
Read MoreNewsFlash: Canadian Cancer Society Recommends Against HRT Use Except as Last Resort
Researchers and representatives comprising the Canadian Cancer Society are recommending that women avoid taking hormone replacement therapy or HRT for any reason other than relief of severe menopausal symptoms that have not responded to other treatments. Wow! Talk about a newsflash!
The reason for last week’s statement is a new study published online in the Journal of the National Cancer Institute that demonstrates an almost 10% decline in the rate of breast cancer among Canadian women between the ages of 50 and 69 following a drop in HRT use.
Utilizing data on HRT prescriptions, incidence of breast cancer, mammography and HRT use in 1,200 women between the ages of 50 and 69, considered primary users of HRT, to a 9.6% decline in the incidence of breast cancer between the years 2002 and 2004. Comparatively, rates during the period of time just before the time studied, i.e. 1998 and 2001, had declined by less than 1%. Incidentally, the more than 50% drop in use of HRT during this time period directly followed reports from the Women’s Health Initiative Study showing a increased risk of stroke, heart attack and breast cancer among users of HRT. Moreover, researchers found that the decline in breast cancer cases were not the result of fewer women getting mammograms; in fact, mammography rates remained stable during this time period.
The researchers say that their results, which are the first in Canada to examine the potential link between widespread declines in HRT use and breast cancer among postmenopausal women, support the Society’s goal of providing Canadian women with information about how to reduce their risk of developing breast cancer. Although the study findings may possibly be limited by the fact that the rely on self-reports of use of HRT and do not take into consieration how often and for how long HRT was used, the researchers claim that the results provide meaningful information on factors that influence breast cancer. Now, they need to determine if HRT promotes or causes breast cancer.
When I asked for a statement from lead study investigator Dr. Prithwish De, he said: “The Canadian Cancer Society’s ongoing review of the evidence on HRT and breast cancer since 2003 led us to our current position and the research study findings reaffirm this position. The Society recommends that women avoid taking HRT for any reason other than to relieve severe menopausal symptoms that have not responded to other treatment. We understand that each woman’s experience with menopause is unique. If, after consulting with their healthcare professional, a woman decides to take HRT, it should be the lowest effective dose for the shortest time possible.”
October is breast cancer awareness month. Educate yourselves and those around you.
Hot Flash Havoc: fear and loathing in the menopause
Author Louise Foxcroft, writing in Hot Flushes, Cold Science, points out that “fear of the menopause is something we have learned, and it has grown out of a general, male and medical distaste for the idea of the menopause perceived as an end to viability, fertility, beauty, desirability and worth. Since the French physician de Gardanne coined the new term ‘ménépausie’ in the early nineteenth century, an onslaught of opinion, etiology, treatments, and not least and lest we forget, profit has followed. Women need to unlearn their dread and recognize that menopause is not, of itself, dread-full; that we are merely the victims of our biological process.”
We have also been victims of the fact that menopause has been “thoroughly medicalized in Western Culture.” The result?
Our bias is to think of menopause as a disease, something that needs to be fixed, treated and eliminated. The solution is inevitably hormone replacement therapy or HRT.
Supporters of HRT will fight tooth and nail against evidence from the Women’s Health Initiative Study that showed that the risks associated with hormone therapy may outweigh the benefits. Their argument lies with the contention that the findings relate to women who were on average, 63 years of age, considerably older than the average age that women start menopause, and that the data are not applicable to younger women. Moreover, had these very women been given hormones earlier, they would have had protection against a multitude of diseases, including heart disease and osteoporosis. Critics of HRT, on the other hand, point to data showing that length of time on hormones, timing of hormones and genetic disposition can increase or decrease a woman’s risk for disease, that HRT doesn’t protect against heart disease or stroke and may in fact, significantly increase disease risk, in particular, breast and ovarian cancer, and death from lung cancer.
Last weekend, I sat through Hot Flash Havoc with a group of female friends. Together, we range in age from 47 to 57. Two of us have had multiple bouts of cancer while three of us have lost loved ones as a result of cancer. Our mothers have had hysterectomies, mastectomies, hot flashes or no flashes. Some are still alive and others have passed. In composite, we are representative of the modern woman: savvy healthcare consumers, avid data hounds, curious, communicative and sometimes outspoken. As one of my friends stated, we are “rolling into a new phase” or have already rolled into it: menopause.
I couldn’t think of a better, more objective way to screen Hot Flash Havoc, “the most provocative and revealing film ever made about menopause.”
Provocative? You bet!
Revealing? Yes!!!!! But not in the way that the director, producers, writers or underwriters intended. Rather than debunk myths about menopause, they have produced a documercial that the women in the room described as:
“Condescending.” “Patronizing.” “Not very well done.” “One-sided.” “Unhelpful.”
And my favorite: “a giant estrogen dildo.”
Hot Flash Havoc promises to “set the record straight about the Women’s Health Initiative study released in 2002, which misrepresented that the hormonal replacement therapy being used by millions of women to treat the symptoms of menopause could actually increase the risk of heart attacks and cancer” and further, “shed insightful light on the confusion stemming from a decade of misguided facts [through] poignant personal stories shared by real women and in-depth interviews with the world’s most noted experts.”
However, the reality is somewhat different. This film of “menopausal proportions” is a meandering, sometimes cartooned montage of HRT hype and bias. Attempts to turn ‘women’s anatomy 101’ into humorous animations of talking vaginas, vulvas and ovaries begs the question: have we somehow stumbled onto a grade school class on menstruation? (By the way, the only thing missing were the tampons and sanitary napkins, which of course, would have no place in the menopause medical cabinet. )
Along with a dash of failed humour is the film’s dose of intrigue, not about the mysteries of a woman’s body but rather surrounding accusations of a government conspiracy underfoot to undermine decades of evidence supporting the use of HRT. Indeed,the National Institutes of Health, which halted the hormone arm of the Women’s Health Initiative study is blatantly accused of attempting to rob women of HRT in a selfish quest fueled by self-promotion.
Wait! The government is conspiring against women who need their hormones???!
The circus-like atmosphere of Hot Flash Havoc is beautifully orchestrated by pro-HRT doctors disputing evidence, ‘enlightened experts,’ and of course, a bevvy of Botoxed babes who went through terrible withdrawal when their doctors made them stop taking their HRT. The message? Women: you’ve been duped!
Hot Flash Havoc misses the mark because it robs the viewer of any objectivity or information about how women and practitioners in different cultures and countries address menopause. Moreover, with the exception of a token naturopath thrown in for good measure, alternative strategies are portrayed as ineffective shams and their proponents, as greedy blood suckers who care more about profit than the women they serve.
One of my friends asked if the film’s intention was to provide enough information to make an informed decision. If so, she said, it fails terribly. Another friend commented that the film portrays menopause as an illness and said that she thought that the film’s underlying message is that menopause is not natural and needs to be cured, that there’s something wrong with you.; ‘it makes me angry,” she said. The overriding complaint was the clincher: this film is really about instilling a fear of aging and illness and the need for a remedy, a ‘miracle’ drug: estrogen.
Hot Flash Havoc is an infomercial of menopausal proportions, a messy mash-up of HRT hype and fear and loathing, a big estrogen dildo just waiting for an opening. Do yourself a favor: don’t let it wreak havoc on your psyche. This one’s a dud.
A huge thank you and love to my Roller girls and partners in crime — Turn A Head, Wendy Wildstar, Biker Babe and Red — for their comments and insight. Couldn’t have written this one without you!
p.s. Bob Dylan wants his album cover back.
Hormone therapy and bones – fuggedaboutit
Another HRT-busting post…straight from the archives of the Ahead-of-Print edition of Menopause. I’m afraid to say that yet, another analysis of the now infamous Women’s Health Initiative Trial, you know, the one that was halted due to links between HRT and significant increases in breast cancer, suggests that hormones might not be so great after all, especially when it comes to bone protection.
The loss of lean body mass as we age contributes to redistribution of fat and apparently contributes to falls and fractures in the later years. This is one reason why many physicians prescribe hormones. However, in the latest nail in the HRT coffin, it appears that despite earlier reports of significant reductions in fractures among women taking HRT based on body mass index, age and bone mineral density, the ability of hormones to preserve lean body mass is a fallacy. In fact, when researchers looked at almost 2,000 women who had been enrolled in the trial who were assigned estrogen plus progestogen, estrogen alone or placebo, they were unable to find any differences in lean body mass after six years, even though there was some indication of protection at the three year mark. What’s more, the researchers say that although women who took most of their hormone medication before the trial was halted seemed to fall less, it wasn’t because their lean body mass was preserved.
The main point in relaying this bit of information is experts want us to believe that HRT is the panacea for everything that ails as women age –from bone health to heart disease to dementia. And despite evolving evidence to the contrary, they continue to seek reasons why the data are wrong and look for ways to question every negative finding. Some Associations whose mandate it is to defend women’s health, like the Society for Women’s Health Research, take money from companies whose hormone products have been found to cause significant adverse effects in certain populations of women and yet, they continue to lead the charge favoring hormone therapy.
In general, I take no issue with Western medicine or pharmaceutical companies. If you look at my background, I have spent years writing favorably about many products and the research that backs them. But I maintain a standard of transparency and don’t choose to hide who’s paying the bills, And, when it comes to hormone therapy, I continue to smell a rat. Be assured that I will continue to write about what’s really going on until more women understand how fucked up HRT really is.
If you choose to take HRT and it works in alleviating your flashes, sweats, mood swings, headaches, sex life and the like, more power to you. I support your right and decision to take HRT. But like any drug, be sure you know the facts before you believe the hype. Be certain to be diligent and ask the hard questions, even when the information comes out of seemingly expert sources or associations. Always, always, follow the trail. You might be surprised at what you learn.
This particular trail, the lean body mass trail? It’s a dead end. Fuggedaboutit.
Next.
Read MoreFDA: Keep children away from topical hormone spray
Do you remember the post back in June about topical hormones, i.e. transdermal sprays, lotions, gels and patches harming your pets? Evidently, they may also be harmful for your children as well. In fact, the Food and Drug Administration has just issued a warning that children should not come in contact with any skin area where Evamist®, a low dose estrogen spray for menopausal symptoms, has been applied.
Similar to reported side effects in animals, the FDA is review reports in children between the age of 3 and 5 years of age who have developed signs of premature puberty following unintentional exposure after a caregiver uses Evamist (the spray is applied on the skin on the inside of the forearm between the elbow and wrist). They include:
- Nipple swelling and breast development/mass in young girls
- Breast enlargement in young boys
The FDA is now saying that exposed pets, especially small animals, who lick or rub their owners’ arms while being held may develop similar symptoms aw well as swelling of the vulvar.
To quote the FDA: “Keep kids and small pets away from skin sprayed with Evamist.”
Yet another reason to stay away from use of hormonal agents and drugs during menopause.
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