Doc offers new view of menopause pills

Her swollen and sore breasts were Dr. Jerilynn Prior’s first hint that menopause wasn’t what the medical establishment said it was. Sitting in her office in the Gordon & Leslie Diamond Health Care Centre, she explained to the Georgia Straight that most doctors link the symptoms of menopause to plummeting estrogen levels.

“But you don’t have to be an endocrinologist to figure out that sore and swollen breasts are a sign of surging estrogen,” she quipped.

Swollen breasts also occur when women are menstruating or pregnant, times when estrogen levels peak, Prior said. Night sweats, hot flashes, mood swings, and trouble sleeping all come during perimenopause, the time before a woman’s last period.

In her studies, the scientific director of UBC’s Centre for Menstrual Cycle and Ovulation Research has found that estrogen levels do rise during perimenopause and don’t drop until after the symptoms normally associated with menopause subside. It’s a drop in progesterone during perimenopause that creates the uncomfortable symptoms, she said.

Prior published her findings in 1998. However, not much has changed so far for women seeking relief, according to Prior. “Even now, women are still going to their doctors when they complain of night sweats and they’re given estrogen [pills or patches],” she said. “It doesn’t make sense.”¦I’ve spent 10 years trying to get this into the medical curriculum, but it’s not there yet. Why? Doctors are slow to change.”

Popping an estrogen-progestin pill for menopause relief developed a bad reputation in 2002 when a headline-making study of 16,600 menopausal women was cut short by the Women’s Health Initiative, under the American National Institutes of Health. The study subjects who were taking the estrogen-progestin pill had a 26-percent greater chance of developing breast cancer; a 29-percent greater chance of heart attacks; a 41-percent greater chance of strokes; and a far greater chance of blood clots than those taking the placebo. The institutes now recommend taking estrogen only in extreme cases.

But Prior thinks she has a better solution. For her own menopause, which she described as “really rough” with sleeplessness and bad night sweats, Prior took progesterone—on its own—to relieve her symptoms.

It worked. For seven years, Prior took progesterone, and it’s the same treatment she offers her clinical patients, to great success.

Starting in 2002, she tried to get a Canadian Institute for Health Research grant to do a major scientific study on progesterone in perimenopause. She wanted to test three groups; to one, she would give a low-dose birth-control pill, which is what most doctors recommend for menopausal symptoms. To another group, she’d give progesterone for days 14 to 27 of the subjects’ menstrual cycles. The third group would get a placebo.

“I kept applying and getting lower and lower [acceptance] scores,” she said, noting that she still doesn’t have a grant. “So, currently, I don’t have any good science. But I do have good clinical evidence. There’s 600 patients I’ve treated and made adjustments [to their progesterone].”

The CIHR did not return the Straight’s request for information by deadline.

Part of the reason Prior’s grants have been refused, she believes, is that menopause, overall, has a very troubling relationship with the medical establishment. Prior thinks it partly stems from the 1966 book Feminine Forever, by Brooklyn gynecologist Robert A. Wilson, who argued that women’s natural hormone changes can be “fixed” through intervention— by giving women hormones.

As he wrote: “For the first time in history, women may share the promise of tomorrow as biological equals of men.” Yet Wilson had a relationship with pharmaceutical companies that was only brought to light after his death.

Eternal youth through hormone treatments, Prior noted, is a myth that still needs busting. Menopause is a normal part of life, she said, so it should not be treated as a disease.

“If instead of looking at menopause as the time you lose your sexuality and your youth, if instead from that time you are young, you see it as, ”˜This is the pattern of my ovarian life,’ where I have that exuberance in youth, I have kids. If there’s a change, and menstruation is gone, then you wouldn’t set yourself up for all that misery.”

Real change for menopausal women, Prior noted, won’t change until the language does. Hormone replacement therapy, or HRT, makes it sound as though women are estrogen-deficent and need their hormones to be replaced, she said. Instead, the surge and drop should be seen as a normal part of life. Prior prefers the term “ovarian hormone treatment” because it doesn’t make women sound deficient.

“There has to be some investment in making women seem sick,” she said, criticizing the establishment’s medicalization of all things female, from premenstrual syndrome to pregnancy. “If women think there’s something wrong with them, they’ll be more likely to accept treatment.”

Prior warns women to be wary of hormone pushers at all stages of life. The birth-control pill, she said, is also made of the hormones estrogen and progesterone (or synthetic progestin). Long-term exposure to the pill lessens bone density and leads to a 300-percent increased risk for blood clots—this risk is escalating as the population gets heavier, she said.

“Blood clots are still very rare, but it’s a tragedy whenever a stroke or a blood clot happens to a healthy young woman,” she said. “You won’t find Planned Parenthood or Options for Sexual Health giving out that information.”

Prior, who is also currently studying whether women can tell on their own if they are ovulating, which could lead to a breakthrough in unassisted fertility, turns 65 this year. Because mandatory retirement was repealed in B.C. as of January 1, she can continue working on her basic premise: that women should have safe, appropriate treatments and the means to understand their own bodies.

If only she could get grants.