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that the wide use of the Pill has given rise to health hazards such While the so-called 'experts' on women's health are reassuring as breast cancer, high blood-pressure and cardiovascular disease | women that there are no, or at least only very minor, unpleasant on a scale previously unknown in medicine.* side-effects, Dr Lynette J. Dumble, Senior Research Fellow at the Investigation into the theory of hormone replacement goes all University of Melbourne's Department of Surgery at the Royal the way back to the 1930s with the research of Dr Serge Voronoff. | Melbourne Hospital, believes that "the sole basis of HRT is to cre- His research involved implanting fresh monkey's testicles into ate a commercial market that is highly profitable for the pharma- men's scrotums, with limited effectiveness. Offshoots of his ceutical companies and doctors. The supposed benefits of HRT research led to the grafting of monkey ovaries in women, with are totally unproven." She believes that HRT not only exacerbates rather dire consequences. After several fatalities (to both monkeys the presenting health problems but also contributes to the ac- and women), the search was redirected to the use of synthetic _celeration of the ageing process of women. It either hastens the oestrogen. With the advent of World War II, research was puton _ onset of other medical conditions or worsens the existing ones. hold. This perspective seems to be validated by the recent findings Menopause didn't really come into vogue as a topic of concern _ from a landmark study, published in The New England Journal of for the medical profession until the 1960s. In 1966 a New York Medicine in 1995, involving 121,700 women, which revealed star- gynaecologist, Dr Robert Wilson, wrote a best-seller called _ tling effects from HRT. It warned that women who used HRT to Feminine Forever, extolling the virtues of oestrogen replacement _ offset the symptoms of menopause also increased their chance of to save women from the "tragedy of menopause which often developing breast cancer by 30 to 40 per cent by taking the hor- destroys her character as well as her health". His book sold over mone for more than five years. In women aged between 60 and 100,000 copies in the first year. Wilson energetically promoted 64, the risk of breast cancer rose to 70 per cent after five ycars of menopause as a condition of "living decay". According to him, HRT. Finally, the study concluded that women using HRT were oestrogen replacement was a kind of long-sought-after youth pill 45 per cent more likely to die from breast cancer than those who that would save poor, fading women from the horrors of age. He —_ chose nof to use HRT or used it for less than five years.° popularised the erroneous belief According to Leslie Kenton, that menopause is a deficiency dis- author of Passage to Power, ease. In women aged between 60 and 64, "everybody who is anybody will Women's magazines eagerly the risk of breast cancer rose to 70% tell you that menopause is an seized upon his ideas and extensive- oestrogen-deficiency disease and + : -° ly promoted his concepts. This after five years of HRT. Finally, the that you will need to take more Carlier setup ‘The Wilson Foun- | Study concluded that women using fh ie rat may surprise you i dation for the sole purpose of pro- HRT were 45% more likely to die this: not only is most of such motng the us of sven crs | from breast cancer than those who ff “ommon'y ven advice. on ously contributed over US$1.3 mil- chose not to use HRT or-used it for it can be positively dangerous.” ‘ " . g : ey in eostred fee dice: mel coo less than five years. Peis, eletornenen panies as Searle, Wyeth-Ayerst spective that not only can assist Laboratories and Upjohn which made women of all ages to attain hormone products that Wilson claimed were effective in treating greater health but also to reclaim a greater sense of power, respon- and preventing menopause. Pharmaceutical companies jumped on __ sibility and dignity in their lives. the bandwagon with aggressive promotions and advertising cam- . : paigns. His message hit a receptive chord: mid-life women need A Brief Gynaecological Tour of a Woman's Body hormone drugs to be rescued from the inevitable horrors and In order to understand the HRT debate, it is important, first, to decrepitude of this terrible deficiency disease called menopause. have a rudimentary knowledge of a woman's cyclic nature. Wilson pioneered the use of unopposed oestrogen. However, Until recently, doctors thought that menopause began when all there had been no formal assessment of the safety of oestrogen _ the eggs in the ovaries had been used up. However, recent work therapy or its long-term effects. Unopposed oestrogen went out of has shown that menopause is probably not triggered by the ovaries vogue when it became obviously apparent that it shortened the —_ but by the brain. It seems that both puberty and menopause are lifetime of its users. In 1975, The New England Journal of _ brain-driven events. Medicine examined the rates of endometrial cancer for oestrogen Menstruation depends on a complex network of hormonal com- consumers, concluding that the risk was seven-and-a-half times munications between the ovary, the hypothalamus and the pitu- greater for oestrogen users. Women who had used oestrogen for itary gland in the brain. The hypothalamus secretes gonadotropin- seven years or longer were 14 times more likely to develop __ releasing hormone (GnRH) which triggers the production of folli- cancer.* cle-stimulating hormone (FSH) by the pituitary gland. The FSH As the popularity of unopposed oestrogen therapy waned, new _ then stimulates the growth of the egg follicles (a small excretory approaches were sought. The focus was also directed away from _ sac or gland) in the ovaries to trigger ovulation. As the egg folli- the false claims of preserving feminine beauty and youthfulness _cles grow, oestrogen is manufactured and released into the blood. and towards more urgent health matters. The pharmaceutical This chain reaction is not just one-way. Oestradiol, one of the industry resurrected oestrogen replacement therapy with the new —_ ovarian oestrogens in the bloodstream, also acts on the hypothala- ‘safe’ hormone replacement therapy—a combination of synthetic mus, causing a change in GnRH. Next, this altered hormone stim- progesterone and oestrogen which would supposedly protect _ulates the pituitary to produce luteinising hormone (LH) which menopausal women not only from cardiovascular disease but also causes the egg follicles to burst and the ovum to be released. from the ravages of osteoporosis. After the egg is expelled, progesterone is also manufactured by the A Brief Gynaecological Tour of a Woman's Body In order to understand the HRT debate, it is important, first, to have a rudimentary knowledge of a woman's cyclic nature. Until recently, doctors thought that menopause began when all the eggs in the ovaries had been used up. However, recent work has shown that menopause is probably not triggered by the ovaries but by the brain. It seems that both puberty and menopause are brain-driven events. Menstruation depends on a complex network of hormonal com- munications between the ovary, the hypothalamus and the pitu- itary gland in the brain. The hypothalamus secretes gonadotropin- releasing hormone (GnRH) which triggers the production of folli- cle-stimulating hormone (FSH) by the pituitary gland. The FSH then stimulates the growth of the egg follicles (a small excretory sac or gland) in the ovaries to trigger ovulation. As the egg folli- cles grow, oestrogen is manufactured and released into the blood. This chain reaction is not just one-way. Oestradiol, one of the Ovarian oestrogens in the bloodstream, also acts on the hypothala- mus, causing a change in GnRH. Next, this altered hormone stim- ulates the pituitary to produce luteinising hormone (LH) which causes the egg follicles to burst and the ovum to be released. After the egg is expelled, progesterone is also manufactured by the 16 © NEXUS JUNE-JULY 1996