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Once upon a time, menopause was a natural female bodily function. Menopause literally means the month of the last menstrual period. The "change of life" - or perimenopause - is the entire transitional period of time from the first signs of change until after menses have ceased completely for more than a year.
Nowadays, the medical establishment views menopause as a hormone deficiency disease. Hormone replacements therapy (HRT) is the routine "treatment" for menopausal women, even healthy women, regardless of the well documented risks associated with these women's hormones drugs. here you will find all the menopause information you need to know.
"Hormones are, without a doubt, some of the most potent health-altering compounds in existence." When the hormones are not naturally produced by the body, there can be serious adverse effects. HRT "works" by suppressing symptoms, but since the biochemistry is so complex, intricate and interactive; the routine use of hormone drugs "is akin to playing with fire."
Once upon a time, hormones were offered to women for only a short time to alleviate menopausal symptoms such as hot flushes, depression, mood swings, inability to handle stress, and vaginal dryness. Today, estrogen (in combination with progesterone for women with an intact uterus) is advised for long periods or lifelong to "prevent" osteoporosis and heart disease, chronic degenerative diseases.
Many researchers feel this is the wrong way to approach such problems. Using drugs of "unknown safety and effectiveness on an entire population" in an attempt to prevent chronic disease conditions does not make sense when lifestyle changes or other therapies, including nutrition, may be more than adequate to prevent, slow, and even reverse these conditions for many women. In other words, there are other options for relieving menopausal symptoms and for offsetting osteoporosis, heart disease, and other problems.
Viewing menopause as a hormone "deficiency" for which "replacement" is needed is the same as viewing depression as a deficiency of Prozac or heartburn as a deficiency of Tums. "Replacement" implies women are supposed to have higher estrogen levels after menopause. Not true.
During child-bearing years, a woman's body normally produces two main groups of female hormones: estrogens and progesterone. When in her mid- to upper-40s or early 50s, a woman's ovaries gradually - and naturally - produce less hormones so that the monthly menstrual period at first may become erratic (skipping, two in a month, etc.), and then ceases altogether. During perimenopause, the ratio of estrogen to progesterone may turbulently fluctuate in some women - sort of puberty in reverse - causing a number of possible symptoms such as hot flushes, vaginal dryness and thinning, urinary tract inflammation, irritability, depression, anxiety, excessive menstrual flow. Some women will simply stop menstruating.
Menopause does not mean ovarian failure. The ovaries continue to produce estrogen and other hormones, at lower levels, at least until the woman is in her 80s or even longer. So, the ovaries do not stop functioning; they just stop producing eggs."
A healthy woman with functioning ovaries does not "dry up like an old prune," does not lose femininity or attractiveness, is not condemned to chronic degenerative diseases. Truly, "hormonal health depends upon having all of the essential nutrients your body needs to produce the right hormones and metabolize [process] them properly." For example, the liver requires the vitamin B complex to break down estrogens and convert them into the safe form utilizable by the body. Nutritional precursors - cholesterol, vitamins A, C and E complexes, essential fatty acids, chlorophyll, total proteins, minerals, trace mineral cofactors, etc. - are needed for synthesis and balance of hormones. Recent studies have uncovered a multitude of "phytoestrogens" or compounds in plants which support hormonal balance when ingested from whole, natural, unaltered foods. Altering a health-depleting lifestyle into a health-promoting pattern can always reap benefits. It is "never too late to start creating hormonal health and balance."
Estrogen (drug) therapy relieves hot flushes, vaginal dryness, and mood swings in most women. Alternatively, nutritional support to the endocrine gland system (especially ovaries, adrenals, thyroid) and to hormonal balance often lessens or alleviates these symptoms. Adjunctive support to the nervous system further aids the emotional or mental aspects. Dietary changes can bring dramatic improvements. Avoiding refined, processed, altered, additive laden non-foods and foul-nutrition, while emphasizing fresh, whole, natural foods including plenty of vegetables and fruits, is recommended. An unrefined oil - wheat germ, almond, or coconut, for instance - applied directly to the vagina may relieve vaginal dryness and itching. Kegel exercises (strengthening the muscles surrounding the bladder and vagina) along with nutritive assistance, can improve urinary control and orgasmic response.
Women who have had their ovaries surgically removed or those who experience severe menopausal symptoms because of the abrupt withdrawal of hormone drugs may not be able to be "managed" by natural remedies alone (though it has been done) so hormone medication may be a necessity.
Contributing to the recent increase in hormonal disruptions are chemical and hormonal poisons and pollutants. By 1996 researchers had identified at least 51 synthetic chemicals - many pervasive in the environment such as pesticides - that disrupt the endocrine system. These hormone disruptors include large chemical families such as 209 PCB compounds, 75 dioxins, and 135 furans. Some mimic estrogen like DES (diethylstilbestrol). "These toxic compounds cause dysfunction of gonadal function, threaten embryonic survival, and increase the risk of breast cancer, urogenital cancers, thyroid dysfunction, and developmental defects in many tissues." The list of hormone disrupting agents continues to grow.
These human-made hormone mimics differ in fundamental ways from plant hormones. The body can break down and excrete the natural plant compounds, and can evidently use some of them to balance and benefit glandular health. Still, more needs to be learned. For example, Orientals ascertained years ago that soy is best handled as food only when it is fermented. Soy products -- unfermented or improperly fermented and mass-produced -- are being promoted for their "phytoestrogens" with possible discomfiting effects.
Synthetic hormone mimics are toxic poisons and can persist in the body. They may be ingested, breathed in from the air, or absorbed through the skin. Some are "estrogenic" (artificially imitating the effects of estrogen) whereas others are "anti-estrogenic" (blocking or interfering with the use of estrogen). Hormone drugs can be consumed in animal foods. For example, growth hormones are injected into meat animals. Another is the bovine growth hormone (somatotropin) given to cows to boost milk production which can have effects when milk or milk products are consumed. Any hormones, even in minute amounts, can have disruptive influence. i
ESTROGEN & PROGESTERONE
Estrogen is a group of 20 related hormones, the most prominent being estrone, estradiol, and their metabolic product, estriol. Progesterone is the other principal female steroid hormone.
"Healthy, well-nourished [ovarian] follicle cells produce a healthy balance of estrogen and progesterone." Dysfunction of the ovary follicle cell from any cause such as toxic insult or nutritional deficiencies, can result in hormonal imbalance, bringing the gamut of symptoms often seen in perimenopausal and menopausal women.
HRT consists of hormone drugs, primarily estrogen. Taken by itself, estrogen causes a buildup of the endometrium (uterine lining), substantially increasing (by four times) the risk of endometrial cancer. Adding progestin (synthetic progesterone) for a woman who has her uterus, prompts the soughing off of the endometrium periodically (like menstruation) and thus reduces, but does not completely eliminate, the risk. If progestin is taken fewer than 10 days a month, the risk of endometrial cancer increases three times. If taken 10 to 21 days a month, the risk is increased only slightly. But, continuing estrogen and progestin more than five years increases the cancer risk two and a half times. Most hormone drugs on the market today are manufactured from the "natural" raw materials found in horse urine, soybeans, or yams. First of all, they are certainly not the hormones produced by a woman's body. Second, they are put through many chemical alterations in the laboratory so they do not resemble the original source. Third, instead of imitating the structure of the female hormones, drug companies usually change the original structure so a patentable product is made. "True natural hormones are considered generic and can't be patented under most circumstances." (The estrogen patch, such as Estraderm or Climera, contains a hormone of similar structure as human so the manufacturers patent the glue on the patch.)
This biochemical manipulation and pharmaceutical substitution for an extremely powerful chemical messenger goes far beyond current understanding of possible ill effects from taking "a steroid structure (hormone) that is foreign to our body..." Dr. Susan Love feels that benefits have been overestimated and risks have been underestimated. Mounting evidence indicates HRT increases the risk of breast cancer as well as many other problems. "Here we were, with this train rushing down the tracks, and no one was standing up and saying, ‘Wait. We don't have all the facts yet.'"
The number one selling drug in the U.S. is Premarin, conjugated oral estrogen derived from the urine of pregnant mares. In 1996, there was $860 million in sales. Although from "natural sources," many components of Premarin are foreign to the human - substances from both the horse and the manufacturing processes. The metabolic breakdown products of Premarin are stronger than the horse estrogens. Estrogens produced in the human are metabolized into weaker compounds, but with Premarin, hormones get stronger with increased potential for harm. "We really don't know the effects of this - especially over a long period of time." Premarin and similar compounds are actually very unnatural hormones.
Prempro is Premarin with a synthetic progestin (Provera) added. Estratab is a mixture of estrogenic substances including horse estrogens. Menest is much like Premarin. Other estrogen drugs include estrogen sulfate and estradiol valerate. Though women make different amounts of estrogen and process it differently, the drugs are often prescribed at the same, "one-size-fits-all" dosage.
There is only one progesterone: the hormone molecule made by the ovary. Progestins used in hormone drugs are synthetic compounds. Illustrating the difference, progesterone is required for survival and development of the embryo and fetus throughout pregnancy. Provera (the most commonly prescribed progestin) increases the risk of early abortion or congenital deformities of the fetus. Provera also increases the risk of coronary artery spasm, and much more. There are many contrasts between natural progesterone and the prescribed synthetic progestins.
Although HRT decreases or eliminates some symptoms experienced at menopause by some women, "it is not a cure," since symptoms reappear if the drugs are stopped. HRT is prescribed to prevent osteoporosis and heart disease, but "the jury is still out on HRT's protective benefits against these diseases." ii
Results of one study indicated that women who started taking estrogen at menopause (usually between ages 48 and 53) and continued into later years had the highest bone density. But women who did not begin HRT until age 60 had bone density almost as high. When women stopped the hormones, the benefits "faded." Women who started HRT at menopause and stopped 10 years later had only slightly better bone density than women who never used the drug.
The advice to take estrogen for five or 10 years after menopause to retard loss of bone density will not prevent hip fracture in later years. Once the hormone is stopped, "bone loss proceeds at its usual pace." So, by the time a woman is 75 - an age of high susceptibility to hip fractures - there is very little difference in bone density between women using hormones and those not taking them. For purported "maximal protection" against fractures, a woman would have to start estrogen at menopause and never stop. The trouble is that long-term HRT increases the risks of breast cancer and other problems.
Bone density screening is advocated for women beginning at menopause. However, no test during this time can accurately predict hip fracture in later years. Such screening is more meaningful for elderly women.
The claim that 50% of women will eventually fracture is misleading. One study projected this idea by adding together the rate of wrist, hip, and vertebral fractures. Ignored was the fact that there are far fewer women with fractures than the total number of fractures because many women (with skeletal problems) have more than one fracture. The risk of hip fracture is only about 16% for Caucasian women aged 50 and 6% for African Americans. "Not every woman loses bone at menopause, as we have been led to believe. Furthermore, osteoporosis is now defined as bone loss, not as fracture."
Estrogen does keep bone density up - as long as it is taken - with about half the fracture rate (not necessarily bone loss rate) than nonusers. Due to such findings, physicians may want to put every 50-year old woman on hormones, "even though not everyone with low bone density will end up with osteoporosis." Bone mass is just one of several risk factors for osteoporosis. And, "low" bone density levels should be determined by comparing older women with each other, not by comparing a 75- year old woman with the average 35-year old woman as is often done.
Osteoporosis is largely preventable. It is not a symptom of menopause. Drug advertisements greatly exaggerate post-menopausal risks of osteoporosis. Photos show hunched-over women with weak backs - an extremely rare situation in the disease. The risk of osteoporosis can be significantly lessened with a wholesome natural diet, food concentrate supplements, moderate exercise, some sunshine, and avoidance of toxic substances adverse to musculoskeletal health.
Many factors affect bone strength and likelihood of fracture especially in industrialized nations. Women tend to consume more carbohydrates than men, often refined and processed sugars and flours which can deplete the body of nutrients such as calcium, and which frequently contain altered (toxic) fats as well. Women are "encouraged" to remain thin, so are more likely to follow unbalanced, deficient diets. Until recently, women were discouraged from being physically active and strong. Smoking is associated with increased rates of bone loss; more women than ever are smoking.
Some researchers think HRT may cause osteoporosis due to the minute blood clots that form in the bone when estrogen is experimentally administered to animals. Estrogen replacement therapy (ERT) also depresses blood levels of alkaline phosphatase, interfering with the ability of magnesium to stimulate calcium deposition in bone. iii
Several studies found women using estrogen experience less cardiovascular disease (CVD). One large study reported half as many heart attacks. Most positive studies find a 35 to 45% lower risk. Other studies have not found a protective role for estrogen. Yet most medical doctors believe estrogen is beneficial.
ERT typically increases HDL (so-called "good") cholesterol and lowers LDL (so-called "bad") cholesterol. Low levels of HDL are believed to be a predictor for CVD risk. However, cholesterol changes do not completely (if at all) explain lower rates of CVD in ERT users. Some speculate estrogen has a direct affect on arteries. So much - including efficacy of long term ERT on coronary artery disease - is "unknown." And, lower cholesterol does not necessarily mean fewer heart attacks or fewer strokes.
Participants in an important study who were taking various types of estrogen over a three year period had lower cholesterol and were developing blood clots and heart disease, whereas women not taking estrogen were not doing so.
Estrogen is usually prescribed for women who are already at low risk for CVD. These women tend to be in an upper income bracket which is associated with lower rates of heart disease, better health, and increased longevity. Women going through natural menopause who later choose to take estrogen are less likely to get heart disease even before they begin to take the hormone. ERT users are less likely to smoke or have high blood pressure or to have diabetes; they are more physically active and leaner -- all these reduce CVD risk. One study found ERT users had higher HDL cholesterol levels before they took estrogen.
In the Framingham study, ERT increased heart attacks by 50% and strokes by 100% due to the increased tendency to form blood clots.
The effectiveness of ERT is sometimes falsely inflated. Two studies found that participants assigned to the placebo group who took their pill every day were less likely to develop heart disease than participants from the same group who did not regularly take the placebo. Taking ERT may be "a marker for successful prevention behavior rather than the cause" of reduced risk.
Also unknown are the effects of taking both estrogen and progesterone (as a third of women using HRT do). Progestins tend to lower HDL ("good") cholesterol and increase LDL ("bad") cholesterol - the opposite of estrogen. One study concluded the hormone combination appears to offer the same cholesterol-lowering benefits as estrogen alone. But, the levels of triglycerides - another suspected CVD risk factor - were raised. A study using estrogen plus either a natural progesterone or synthetic progestin (medroxyprogesterone acetate, the most widely prescribed) concluded that the synthetic form poses a "huge risk." It can "obliterate the beneficial effect of estrogen on the progression of coronary artery atherosclerosis." As far as heart disease protection, "it's worse than no treatment at all." In fact, it is "a really dangerous drug."
Current use of estrogen or estrogen/progestin "does not significantly increase or decrease the risk"of heart attack in postmenopausal women. Evidence shows that "broad promotion of estrogen for the menopause to reduce heart attack is not warranted." If the general rate of CVD is declining as claimed, and if women have less heart disease than men, why is so much attention being focused on an unproved drug? It is admitted that "the studies are imperfect." Though estrogen is presented as if its benefits are proven, "its supporting research leaves much to be desired."
"ERT has proven to be less effective in preventing osteoporosis and heart disease than a change in diet." Most medical doctors know little about nutrition and how diet affects health. "They rely instead on knee-jerk prescribing, which is continually encouraged by drug manufacturers' aggressive promotions." Regular exercise, a natural wholesome diet, whole food supplements, avoiding tobacco, and avoiding overweight will lower the odds of developing heart disease - "without nasty side effects" such as breast cancer. CVD is largely preventable without drugs.
No one has proved HRT spares women from heart disease. A clinical trial is now in progress, but the results will not be known for years. The idea that HRT is protective against CVD "has been based on inadequate evidence." A study of 22 trials involving over 4100 women found no evidence that short-term use of HRT was protective against heart disease. Doctors have little knowledge of long-term effects, so the impact may not be seen for some time. "Our results do not support the notion that postmenopausal hormone therapy prevents cardiovascular events." iv
LONGEVITY and ALZHEIMER'S
Women taking HRT (estrogen or estrogen/progestin) were 23% less likely to die during a 10-year period as women not taking hormones. In another study woman currently taking estrogen had a 37% lower risk of premature death than women who had never taken hormones.
But, healthier women are more likely to take hormones, so they would be expected to live longer even without hormones. And women taking the more potent estrogen or hormone combinations had up to twice the risk of suicide as women not taking them. Also, the findings showed the longevity benefit is primarily in women with "risk factors" for coronary disease. If the drugs are taken longer than 10 years the longevity "advantage" diminishes to 20%, and the odds of dying of breast cancer increases 43%. So maybe there is benefit to the cardiovascular system (purported "risk factors" are not always accurate predictors), but the chance of breast cancer increases. Lack of data on combined estrogen/progestin "may limit extrapolation of" the findings "to current care."
Some studies seem to show ERT may lower the risk for memory loss and Alzheimer's. In one study, "data on hormonal status and memory were examined" based on reports from women receiving ERT during cognitive (thinking/memory) assessment. The scores of the two groups - one receiving ERT, the other never having taken ERT - differed by about ¼ of a standard deviation. The women taking estrogen had about two fewer errors.
Another study reported significantly lower risks of developing Alzheimer's - the longer estrogen was taken, the better. Interpreting the data, the head researcher "estimates" that women taking the drug for 10 years reduce their odds of getting Alzheimer's by almost 40%. However, scientists cautioned that the study "does not provide enough evidence" to establish that most older women should take estrogen.
One study was funded in part by Wyeth-Ayerst, the pharmaceutical company that makes Premarin. A new nine-year study now in progress is being funded 100% by Wyeth-Ayerst. There is no surprise that the first study linked ERT to a lower risk for dementia. And there will be no surprise if the results of the new study say the same.
A meta-analysis reviewing many studies concluded there are "plausible biological mechanisms" by which estrogen "might" lead to improved mental acuity, reduced risk for dementia, or improvement in the severity of dementia. However, studies "have produced conflicting results." And, considering the known risks of ERT, the researchers "do not recommend estrogen for the prevention or treatment of Alzheimer disease or other dementias until adequate trials have been completed." (Emphasis added)
The less money a person has, the higher the incidence of Alzheimer's. The less money a woman has, the less likely she would use hormones. So women most likely to develop any dementia are least likely to use hormones. Also, Alzheimer's is not a woman's disease. There is no conclusive evidence that ERT prevents Alzheimer's. There is consistent evidence linking ERT with breast cancer. v
Many researchers have identified evidence of increased risk of breast cancer associated with the use of HRT. Women taking estrogen alone had a 36% higher risk. Those taking estrogen and progestin had a 50% increase. Another study found a 50% higher risk in women who take ERT for five to 10 years, a lower risk for four years or less. Five to nine years of hormone use raised breast cancer risk 59%, with an added risk of 35% in HRT users who were age 55 or older. The risk of death from breast cancer increased by 43% among women who took HRT for more than 10 years. The unproved "protection" from cardiovascular disease or osteoporosis - typically occurring at older ages than breast cancer (75 to 80 versus 65) - is surely reduced with these odds!
Some believe that researchers tend to underestimate cancer risks. For example, it is likely that women at high risk for breast cancer are not put on estrogen. Further, it is not known how estrogen therapy will affect women who took high-estrogen birth control pills in the 1960s and 1970s. Are such women at risk because of their "age" or because they were once on the "Pill"?
Mammography is much less accurate for women taking ERT because the density of the breast tissue is increased. Increased density can appear to be a tumor and lead to a false positive ("false alarm") test result. The denser the breast, the less likely real cancers would be detected.
An analysis of 90% of the research on HRT and breast cancer found that the drugs do increase the risk and continue to increase it the longer they are used. This "effect" decreases after HRT is stopped, largely disappearing five years later. The average length of time a woman takes HRT is 11 years. Risk begins after only one year of use and increases 2.3% each year. Obviously, "estrogen increases breast cancer risk much more than previously thought...women ages 60 to 64 who had been taking estrogen five or more years had a 71% higher risk!" vi
Several studies indicate that ERT may increase the risk of ovarian cancer, which is usually fatal. Estrogen is also implicated in the development of endometrial (uterine) cancer.
HRT increases the risk of venous thromboembolic events (VTE) - blood clots, including pulmonary embolism (clot in the lung), leg phlebitis, heart attack, and stroke.
Women receiving HRT are 70% more likely than non-users to be suffering from temporomandibular disorders (TMD), a chronic and painful condition of the jawbones and surrounding musculature.
Systemic lupus erythematosus (SLE) is an inflammatory disorder of connective tissues that can affect any organ of the body from the heart to the liver. There is an increased risk for lupus with increased use of estrogen.
Women using estrogen have a 50% greater risk of developing asthma than those who never used hormones. The longer the hormones are taken, the greater the risk of asthma.
Moderate alcohol consumption increases levels of circulating estrogen three-fold among hormone users, thus increasing the health risks such as breast cancer.
Estrogens in HRT are "psychoactive." Their use has powerful psychological effects, so can lift mood or induce excitation, for example. Reports indicate dependence on the drug can develop, with high tolerance requiring increasing quantities to produce the same results and then experience heavy withdrawal symptoms. Thus women may feel better because the drug relieves symptoms or because it is a euphoriant ("upper") and they become addicted. Some women who develop resistance to estrogen (just as addicts develop resistance to cocaine or heroin) have estrogen levels 10 times higher than much younger women!
Increases in the following have also been described in medical and other scientific journals: gallbladder disease, nausea, headache, bloating, irritability, breast swelling and pain, uterine cramping, enlarged uterine fibroids, mood disorders, depression, suicide, irritability, anxiety, agoraphobia, amnesia, nerve cell damage, weight gain, kidney disease, pituitary tumors, lung cancer, liver disease, liver cancer, colon cancer, malignant melanoma, meningioma and other brain cancers, osteoarthritis, rheumatoid arthritis, allergies, porphyria, optic neuritis, epilepsy, low blood pressure, fainting, varicose veins, arrhythmias, blood vessel spasm, glucose disturbances, hypothyroidism, excess body hair, loss of hair, skin discoloration, thinning of the skin, and edema.
Synthetic testosterone, included (with estrogen) in Estratest can cause excess hair growth and/or male pattern baldness, anger, aggressiveness, jitteriness, sleep problems, excessive libido (sex drive). vii
WHY MEDICATE MENOPAUSE?
About 35% of women in the U.S. take hormones during menopause. More and more physicians recommend that perimenopausal, menopausal, or post-menopausal women take "replacement" hormones.
Though there have been hundreds of trials studying HRT, "adverse effects have not been systematically reported." Additionally, "few doctors have received proper training about the therapy and many rely on drug company representatives for most of their information."
Dr. Isaac Schiff, chief of obstetrics and gynecology at Massachusetts General Hospital, observed: "Basically you're presenting women with the possibility of increasing the risk of getting breast cancer at 60 in order to [perhaps] prevent a heart attack at 70 and a hip fracture at age 80."
Raymond Peat, a veteran health researcher and writer, was appalled at his investigative findings. "It simply isn't safe at all to take estrogen" since dangers are already known and long-term effects are not yet known. Proved and suspected hazards indicate "it's not even safe in low doses."
Adverse nutritional effects can be added to the risk list. Women taking hormones tend to have lower serum concentrations of zinc, magnesium, manganese, and bone alkaline phosphatase, as well as higher copper concentrations than other postmenopausal women. What of the possible induced alterations - not yet researched - to other minerals, to vitamin complexes, essential fatty acids, proteins, etc.?
Many women feel worried, skeptical, or discouraged about the effects of HRT. "Have politics and therapeutic dogmas controlled women's health for too long?" Should not women take control of their own health by becoming informed and by making informed choices? Taking control also means taking responsibility for one's own health by avoiding tobacco and other noxious substances, by eating whole, natural foods, by exercising, and by obtaining professional guidance on food supplementation if indicated. Perhaps then a woman could live happily ever after. viii
i National Women's Health Network, Taking Hormones and Women's Health, 1995, pp.9, 14-16; J. Heimlich, Health & Healing, Nov 1994, pp.1-2; T. Valentine, Search for Health, Vol.3, No.5, May/June 1995, p.12; Health Facts, Vol.22, No.3, Mar 1997, pp.5-6; D. Williams, Alternatives, Vol.6, No.7, Jan 1996, pp.54-55; C. Northrup, Health Wisdom for Women, Vol.5, No.1, Jan 1998, pp.2-3; T. Colborn, et al, Our Stolen Future, NY: Penquin, 1997, pp.81-82; J. Ashley, Science News, Vol.145, No.14, 2 April 1994, pp.211, 220; J. Lee, Natural Progesterone, Sebastopol: BLL Pub, 1993, p.13.
ii C. Northrup, Health Wisdom for Women, Vol.4, No.7, July 1997, pp.2-3 & Vol.5, No.7, July 1998, p.7; J. Lee, Natural Progesterone, pp.14, 34; Health News, Vol.4, No.5, 20 Apr 1998, p.7 & Vol.3, No.4, 25 Mar 1997, pp.1-2; M. Diver, Lancet, Vol.340, No.8833, 12 Dec 1992, p.1471; J. Whitaker, Health & Healing, Vol.7, No.6, June 1997, p.7; W. Douglass, Hormone Replacement Therapies, Atlanta: Second Opinion, 1996, p.5; Health Facts, Vol.23, Is.7, July 1998, p.6.
iii Health News, Vol.3, No.4, 25 Mar 1997, p.1; J. Heimlich, Health & Healing, Nov 94 (S), p.2; Health Facts, Vol.22, No.7, July 1997, p.5 & Vol.20, No.194, July 1995, p.2 & Vol.22, No.3, Mar 1997, p.6; R. Mestel, Health, Vol.12, No.5, Jul/Aug 1998, p.115; J. Challem, Natural Health, Jan/Feb 1998, p.171; Taking Hormones and Women's Health, pp.18-19; Hormone Replacement Therapies, pp.5-6; JAMA, D. Schneider, Vol.277, No.7, 19 Feb 1997, pp.543-547 & L. Speroff, et al, Vol.276, No.17, 6 Nov 1996, pp.1397-1403 & K. Insogna, et al, Vol.276, No.17, 6 Nov 1996, pp.1430- 1432; J. Raloff, Science News, Vol.150, No.19, 9 Nov 1996, p.293.
iv Lancet, C. Webb, et al, Vol.351, No.9115, 23 May 1998, pp.1556-57 & P. Collins, et al, Vol.341, No.8855, 15 May 1993, pp.1264-65; Health News, Vol.3, No.12, 16 Sept 1997, p.7 & Vol.3, No.10, 5 Aug 1997, p.7; Health Facts, Vol.20, No.194, July 1995, p.2 & Vol.22, No.3, Mar 1997, p.6 & Vol.22, No.7, July 1997, p.5; J. Raloff, Science News, Vol.151, No.10, 8 Mar 1997, p.140; D. Petitti, Annals of Epidemiology, Vol.4, 1994, pp.115-18; JAMA, Vol.273, 1995, pp.199-208 & Vol.277, No.2, 8 Jan 1997, p.103; Health Watch, Vol.2, No.5, 1997, p.6 & Vol.1, No.9, Jan 1997, p.4 & Vol.2, No.7, Dec 1997, p.2; T. Valentine, Search for Health, Vol.3, No.5, May/June 1995, p.11; British Medical Journal, July 1997, pp.149-153; Maturitas, Oct 1996, pp.107-14; J. Heimlich, Health & Healing, Nov 1994 (S), p.2; J. Mercola, Townsend Letter for Doctors, Jan 1998, p.26; Health, Vol.II, No.6, Sept 1997, p.20 & Vol.12, No.5, Jul/Aug 1998, pp.112-13; Taking Hormones and Women's Health, pp.22-25; Women's Health Letter, Dec 1995, p.7.
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Originally published as an issue of Nutrition News and Views, reproduced with permission by the author, Judith A. DeCava, CNC, LNC.