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The Estrogen Merry-Go-Round

by The Social Diary Health Columnist Ruth S. Jacobowitz
Column #3, January 10th, 2006

I can’t believe I’m going to write more about the Women’s Health Initiative (WHI) and estrogen, but here goes. Last month I was lecturing on a ship and was scheduled to give my lecture “The Estrogen Dilemma: What Do We Do Now?

Two days before the scheduled topic, I ran into a friend from the United Kingdom with whom I’ve sailed before. Her name is Yvonne. She said, “Boy, am I glad to run into you before your lecture. I can’t wait to show you what was in Britain Today.” (Point of explanation: On the ship, all the Americans have a mini-New York Times delivered to their staterooms each day and the Brits received their mini publication).

“Don’t move a muscle,” she said and ran to her stateroom, returning quickly with the publication. “What do you think of this?” she asked. I couldn’t believe my eyes. There in black on white was the vindication I had known would come for, as my friends are aware, I have always believed that the WHI was seriously flawed and I have never believed that we needed to change anything we were doing based on its results.

Before I quote the article in Britain Today, come back with me if you will as we chart a brief history of estrogen use. 1966-a book by a Brooklyn gynecologist, Dr. Robert A. Wilson entitled “Feminine Forever” promises women that estrogen is the fountain of youth. 1976-a couple of articles in the New England Journal of Medicine report a few incidences of uterine cancer in women who take estrogen. The fountain of youth dries up! 1980s-scientists figure out that if estrogen is cycled with progestin each month, as women’s premenopausal bodies do, the risk of uterine cancer would be avoided and that’s where we were until the WHI. In fact, during the 80s, 90s, and even for a couple of years after we crossed the millennium, most physicians told most women to take estrogen for the rest of their lives.

The next big change came about in July, 2002 when the WHI stopped its arm of the study in which women with an intact uterus took Prempro—the only estrogen plus progestin product used in the study. Then in March, 2004, the WHI stopped the estrogen alone arm of the study. Now the medical wisdom seems to be that it’s best if women complaining of menopausal symptoms take the lowest dose of estrogen for the shortest period of time.

Wait until you hear this. The headline in Yvonne’s article is “Women May Have Been Mislead on HRT and Heart Disease.” Then the article goes on to say, and here I quote, “Scientists said that the Women’s Health Initiative study, which reversed many experts’ opinion about HRT, could not possibly have detected a beneficial effect on heart health given the way it was designed.”

The article continues, “The new research, led by Dr. Frederick Naftolin from Yale University, concluded that the WHI was underpowered by a factor of 10 and would have had to enroll thousands more participants to have any statistical relevance.”

Whew! Finally a challenge to the flawed WHI! Women need to be comfortable and do whatever contributes to that feel good/look good philosophy and many women in the US and the UK and elsewhere who quickly ditched their hormones in the aftermath of the WHI results have raced back to their estrogen. Now I’m not interested in encouraging or discouraging the use of estrogen, but as Jack Webb always said on Dragnet, “Just the facts, Mam.”


* Ruth S. Jacobowitz is an award-winning medical writer, dynamic lecturer, columnist and former vice-president of a teaching hospital in Cleveland, Ohio. The Estrogen Answer Book, is her fifth women’s midlife health book. She is also author of 150 Most-Asked Questions About Menopause; 150 Most-Asked Questions About Osteoporosis; and 150 Most-Asked Questions About Midlife Sex, Love, and Intimacy.

Her first novel, Final Acts, a medical/legal thriller was published in September, 2004.

Ruth’s engaging and informative lectures have taken her all over the world. She educates men and women about how they age and empowers them to take charge of their own health. Her books are published in 14 languages. She has been on 48 Hours, Today, CBS This Morning, Donahue, Leeza, America’s Talking, Food Television Network, People are Talking as well as on local television news and talk programs and in the New York Times, Washington Post, Vanity Fair, Newsweek, and on National Public Radio.

Visit Ruth at her website www.ruthjacobowitz.com .

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