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Dr John Lee offers a more enlightened view: "My hypothesis is that the increased risk of cardiovascular disease now associated with menopause may not be due to relatively minor cholesterol plaque or to hormone deficiency per se, but to increased risk of coronary vasospasm caused by synthetic progestins, such as medroxyprogesterone acetate (Provera), used in HRT. This does not ignore the effects of aging and other factors. It points the fin- ger at a dangerous drug. "There's absolutely no excuse for any doctor to prescribe Provera for HRT when we have this kind of data. HRT should include small, physiologic doses of transdermal natural proges- terone, which will protect against coronary vasospasm, combined with very small amounts of estrogen, when needed. "When it comes to optimal cardiovascular health, some women may benefit from a small amount of estrogen. But it is quite prob- able that, for many women, postmenopausal production of estrone in fat cells may be sufficient when supplemented with natural progesterone."”” The huge financial investment by the pharmaceutical compa- nies and the medical establishment to research, promote and edu- cate the public as well as medical doctors about oestrogen's and progestin's absolutely key role in women's health has transformed an hypothesis into an unassailable fact. However, as the truth is teased out from the myths, what becomes apparent is that this widespread use of steroid supplementation in healthy women is indeed a dangerous and still unproven theory. Combined oestrogen and progestin have over 120 possible side- effects and risks, as acknowledged by the pharmaceutical compa- nies themselves in warnings published in the Physicians Desk Reference. Hopefully the HERS study was a reality check to the medical profession, reminding them that the cautions written on the packet inserts as well as in the Reference—stating that both oestrogen and progestin can cause strokes, blood clots, high blood pressure and thickening of the blood, which put users at serious risk of heart attacks—are not warnings of rare or infrequent events. Individually, oestrogen and progestin are potent drugs; however, when combined, their alchemy creates an even more dangerous and volatile mix. In commenting about oestrogen, Dr Elizabeth Barrett-Connor sums it up poignantly: "No other prescription drug has been given on such a large scale to prevent disease in healthy women without proof of efficacy by a randomised clinical trial."* The over-zealous prescribing of HRT to women for heart dis- ease is based on unsubstantiated data and incomplete research. Professor Alistair MacLennon, Associate Professor of Obstetrics and Gynaecology at the University of Adelaide, Australia, so much as admitted this fact when he was quoted as saying: "It [using HRT as a cardiovascular protective agent] is cial exper- iment at the moment based on indirect data."” A social experi- ment? Do women really want to be the guinea pigs in yet another massive experiment, be it either social or medical, trialling a potentially debilitating and lethal drug therapy? It is undeniable that heart disease is a major cause of death among older women. However, neither menopause nor oestrogen deficiency can be assigned the role of villain, but rather a combi- nation of factors which include lifestyle, diet, stress, and ageing itself. It is alarming to realise that for some women the present trend to be prescribed hormone replacement therapy as either a primary or secondary treatment is, in fact, not only contributing to this disease but actually causing it. Needless to say, the conse- quences to women's health are devastating. Just as the Victorian procedures that once resulted in needless suffering to so many women are now condemned as bizarre and barbaric mistakes, so, too, in the not-too-distant future, the wide- spread use of synthetic oestrogen and progestin will also be added to the ranks of major medical mistakes. oo About the Author: Sherrill Sellman is the author of the best-selling book, Hormone Heresy: What Women MUST Know About Their Hormones. She is a psychotherapist, a lecturer and a contributing writer to many international magazines on women's health. As a women's health advocate, Sherrill has established the Natural Hormone Health Advisory and Referral Service in Australia for personally coun- selling women to regain their hormonal health—naturally. For more information, telephone 1902 211191 (Australia only). Endnotes E. N. Meilahn and P. Plantinga, "Prior to use of postmenopausal estrogen/progestin interventions 1. Fido, Martin, The World's Worst Medical estrogen replacement therapy, are users (PEPI) trial", JAMA 272(3):199-208, 1995 Mistakes, The Book Company International, healthier than non-users?", American Journal of 19. Wright, Jonathan, MD and John Sydney, Australia, 1996, p. 132 Epidemiology 143:971-978, 1996 Morganthaler, Natural Hormone Replacement, 2. Sellman S., Hormone Heresy: What Women 12. Haynes, S. G. and M. Feinlieb, "Women, Smart Publications, California, USA, 1997, p. 77 MUST Know About Their Hormones, GetWell work and coronary heart disease: Prospective 20. Ibid. International, Melbourne, Australia, 1997, p. 5 findings from the Framingham heart study", 3. Tunstall-Pedoe, H., "Myths and paradox of American Journal of Public Health 70(2):133- ain (ie , coronary risk and the menopause", Lancet 141, 1980 22. Op. cit., p. 78 351:1425-1427, 1998, quoted in Australian 13. Barrett-Connor, E.,U.Goodman-Gruenn et 23: Miyagawa, K., J. Rosch, F. Stanczyk and K. Doctor, November 13, 1998, p. 31 al., "Prospective study of endogenous sex Hermsmeyer, "Medroxyprogesterone interferes 4. "The Menopause Mystery", Australian hormones and fatal cardiovascular disease in with ovarian steroid protection against coronary Doctor, November 13, 1998, p. 31 postmenopausal women", British Medical artery vasospasm", Nature Medicine 3:273-274, 5. Love, Susan, MD, Dr Susan Love's Hormone _ Journal 311:1193-1196, 1995 1997 Book, Random House, New York, 1997, p. 97 14. Hulley, S., D. Grady, T. Bust et al., 24. Lee, op. cit., p.5 6. Sellman, op. cit., p. 64 "Randomized trial of estrogen plus progestin for 25. Ibid. 7. Love, op. cit., p. 9 ; secondary prevention of coronary heart disease 26. Collins, P., "Estrogen replacement therapy 8. Lee, John R., Dr, The John R. Lee Medical in postmenopausal women", Journal of the and exercise performance in postmenopausal Letter, August 1998, p. 3 American Medical Association (JAMA) 280:605- women with coronary artery disease", American 9. Consumer Guide to Prescription Drugs, 13, 1998 Journal of Cardiology 81 (2):259-260 71 998 Publications International, 1995, pp. 397,569 15. "Heart Study Fears", Herald-Sun, op tl : Ne . , 10. Colditz, G.A., "The Nurses Health Study: Melbourne, Australia, September 12, 1998 0 W884 CIP Cito D: a Findings during 10 years of a follow-up of a 16. Love, op. cit., p. 107 28. Barrett-Connor, E. and V. Miller, "Estrogens, cohort of US women", Current Problems in 17. Lee, op. cit., p. 185 lipids and heart disease: Care of the older Obstetrics and Gynecology Fertility 13:129-174, 18. Writing Group for the PEPI Trial," Effects of | woman", Clinics in Geriatric Medicine 1(9):57- 1990 estrogen/progestin regimes on heart disease risk 67, 1993. 11. Matthews, K. A., L. H. Kuller, R. R. Wing, factors in postmenopausal women: The 29. Australian Doctor, op. Cit., p. 32 24 - NEXUS FEBRUARY — MARCH 1999