Menopause Is Not a Disease
By Neal D. Barnard, M.D., and Kristine Kieswer

This commentary was published in a number of newspapers in July 2002, including the Houston Chronicle (July 25) under the title “Drugs Aren't the Best Prescription for Menopause.”

The government's recent early termination of the Women's Health Initiative (WHI) study of hormone replacement therapy raises a disturbing question: Should it ever have happened?

In previous hormone studies, some women died; others became seriously ill. It's time to stop and consider why our medical establishment is turning every biological event-even something as natural as menopause-into a condition in need of drug treatments.

Of course, drug companies are pushing more than hormones. Watch 30 minutes of television and you're virtually guaranteed to see a prescription drug ad. If high cholesterol, hay fever, or chronic and persistent heartburn haven't gotten you, eventually impotence, incontinence, or hot flashes will, they seem to say. But, is this pill-for-every-ill system of ours making us any healthier? Not quite.

The use of prescription drugs-properly prescribed-now ranks as the fourth leading cause of death in U.S. hospitals. With odds like these you'd think that physicians would be pushing prevention, not drugs, at every turn. And some do. But, it has become just too easy to write a prescription, bill it to insurance, and ignore the consequences. Under ever greater time constraints, with free drug samples a plenty, it's easier to send patients home with instructions to "take one tablet two times a day" then to broach those vital subjects of diet, exercise, and emotional well-being.

It's this very lack of attention to lifestyle factors that may be causing women to suffer through menopause needlessly, or risk serious illnesses by gambling with hormones.

Studies show, in fact, that women can avoid the issue of estrogen use entirely by boosting fiber-rich foods such as vegetables, fruits, beans, peas, lentils, and whole grains, for example. Many women in other parts of the world who grow up eating vegetarian diets pass through menopause with hardly a hot flash. The reason is, high-fat animal products (meat, cheese, dairy products, and eggs) can artificially increase the body's circulating estrogen throughout life, making the hormone shift at menopause feel much worse.

Fiber-rich plant foods do just the opposite by removing excess estrogen, allowing the body to adapt to lower levels throughout life and skipping the symptoms of plummeting hormone levels at menopause. These foods are nature's way of balancing hormones. Soy foods such as tempeh, tofu, and soymilk contain phytoestrogens (plant estrogens) that attach to estrogen receptors on cells that would otherwise be occupied by the body's own estrogen, therefore lowering cancer risk. A low-fat diet free of animal products also protects against heart disease and osteoporosis. If drug companies could have bottled a vegetarian diet, we may have avoided the hazards of HRT altogether.

In case anyone was confused by conflicting media reports of the WHI findings, the study found that women taking hormones for five years had a 26 percent increased chance of developing breast cancer. And the trouble didn't end there. The risk of heart attack for women in the hormone group was 29 percent higher than for those in the placebo group. For strokes and blood clots, risk increased 41 and 111 percent, respectively.

Surprising to many women, research has been uncovering holes in the hormone story for years. A 1999 study found that estrogen use after menopause did not protect against heart attacks. An earlier study in the Journal of the American Medical Association reported that, if anything, hormones aggravated heart problems and contributed to blood clots and gallbladder disease. In 2001, the American Heart Association warned against hormones use to prevent cardiovascular disease. Again, in 2002, the nearly seven-year-long HERS study confirmed that hormones did not reduce the risk of heart problems in postmenopausal women with heart disease. In fact, their risk of blood clots doubled-indeed, three women died from blood clots lodging in their lungs-and their need for gallbladder surgery increased as well.

There is an easier way. Women should seek out practitioners who understand the vital links between diet and health and are comfortable with alternative and traditional treatments alike. Readers are invited to read more about diet and menopause at www.pcrm.org.

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Neal Barnard, M.D., is the president of the Physicians Committee for Responsible Medicine (PCRM). Kristine Kieswer is the author of Healthy Eating for Life for Women and the editor of PCRM's Good Medicine magazine.

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